PURPOSE The goal of our study was to provide a general overview of noncompliance with palliative systemic therapy in distant metastatic breast cancer (MBC). METHODS We analyzed an unselected cohort of 339 patients who were diagnosed with MBC over a 22-year period (1990-2011, age restriction: ≥ 85 years old). RESULTS Forty patients (11.8%) rejected the offered or recommended systemic therapy (age distribution of this noncompliance subgroup: ≤60 years at MBC diagnosis: 7.9%; 60-70 years: 13.2%; > 70 years: 15.6%). The rate of noncompliance was equally distributed over time (1990-1999: 12.2% vs. 2000-2011: 11.5%, p = 0.87). Compared to patients who had received palliative antineoplastic systemic therapy, those who remained untreated were significantly older (70 vs. 61 years, p = 0.015), had shorter metastatic disease survival (2 vs. 27 months, p < 0.001), had more often an aggressive tumor subtype (hormone-receptor negative carcinomas: 48.7% vs. 22.2%, p < 0.001), and had more often secondary MBC (95.0% vs. 73.6%, p = 0.001). CONCLUSIONS Although the high rate of noncompliance in the subgroup of elderly patients was not unexpected, it is noticeable that even in the subgroup of patients who were younger than 60 years, approximately 8% also rejected any systemic therapy before a MBC-related death occurred This group of younger women rarely had any relevant comorbidities, were potential candidates for chemotherapy and knowingly declined the therapy options. Such patients are never or seldom seen by oncologists in their daily practice and therefore play a minor role in their personal perception of disease. Nevertheless, these under-reported cases make up a significant proportion of MBC.

中文翻译：

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远处转移性乳腺癌患者不遵守姑息性全身疗法：肿瘤科医生的盲点？

目的我们的研究目的是提供对远处转移性乳腺癌（MBC）不符合姑息性全身疗法的一般概述。方法我们分析了22年来（1990年至2011年，年龄限制：≥85岁）被诊断为MBC的339例患者的未选队列。结果40例患者（11.8％）拒绝了所提供或推荐的全身治疗（该不依从亚组的年龄分布：MBC诊断时≤60岁：7.9％； 60-70岁：13.2％；> 70岁：15.6％）。违规率随时间平均分配（1990-1999：12.2％vs. 2000-2011：11.5％，p = 0.87）。与接受姑息性抗肿瘤全身治疗的患者相比，未接受治疗的患者年龄明显更大（70岁比61岁，p = 0.015），转移性疾病的生存期更短（2 vs. 27个月，p <0.001），更具侵略性的肿瘤亚型（激素受体阴性癌：48.7％vs. 22.2％，p <0.001），以及继发性MBC（95.0％vs. 73.6％，p = 0.001）。结论尽管老年患者亚组的高不依从率并非意料之外，但值得注意的是，即使在60岁以下的亚组患者中，约8％的患者也拒绝接受任何全身治疗，直到发生MBC相关死亡。一组年轻妇女很少有任何相关合并症，可能是化疗的候选者，并明知拒绝治疗选择。肿瘤科医生在日常实践中从来没有或很少见到过这样的患者，因此在他们对疾病的个人认知中起次要的作用。不过，