Comprehensive geriatric assessment in 326 older women with early breast cancer

Okonji, David; Sinha, R. K.; Phillips, I.; Fatz, Duncan; Ring, Alistair

doi:10.1038/bjc.2017.257

Cited by 32 publications

(24 citation statements)

References 40 publications

(33 reference statements)

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“…But recent population data indicate that OS for BC in older patients improves with adjuvant RT . The heterogeneity of the elderly population also complicates the choice of the most appropriate treatment for such patients . In this oncological scenario, there is a paucity of published data on the safety and efficacy of Hypo‐RT in relation to the impact of aging and comorbidities.…”

Section: Discussionmentioning

confidence: 99%

Hypofractionated irradiation in 794 elderly breast cancer patients: An observational study

et al. 2019

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To assess the efficacy, and the acute and late toxicity of hypofractionated radiotherapy (Hypo‐RT), and the impact of age and comorbidities on disease progression and death in elderly breast cancer (BC) patients. Women aged ≥65 years who received Hypo‐RT (42.4 Gy in 16 fractions, plus a boost for high‐risk patients) were considered for the present analysis. Competing risk analysis was used to estimate the 5‐year cumulative incidence of BC progression and BC‐related death, calculating the adjusted subhazard ratios (SHR) with 95% confidence intervals (95%CI) in relation to age, hypertension‐augmented Charlson Comorbidity Index (hCCI), tumor characteristics, and chemotherapy. The sample included 794 patients with a median age of 74 years (range 65‐91 years). At the baseline, 70% of these patients had at least one comorbidity. With a median follow‐up of 48.3 months, the 5‐year cumulative incidence of BC progression and BC‐related death was 6.7% (95%CI 4.8%‐9.2%) and 2.3% (95%CI 1.2%‐3.9%), respectively. Old age (≥80 years) and a high burden of comorbidity (hCCI ≥ 2) were independently associated with BC progression. Hypo‐RT is safe in elderly BC patients, but age and comorbidities influence BC progression. Further studies are warranted.

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Section: Discussionmentioning

confidence: 99%

Hypofractionated irradiation in 794 elderly breast cancer patients: An observational study

et al. 2019

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“…Irrespective of the purpose of the CGA, patients with increasing age were more likely to be described as unfit or frail [37,38], and had poorer survival and breast cancer treatment outcomes [38e40]. Two prospective studies evaluated whether routine CGA altered breast cancer treatment decisions [41,42] and reported different findings. In the study by Okonji et al, women defined as unfit or frail were less likely to undergo surgery or receive adjuvant chemotherapy [42].…”

Section: Tools For Identifying Frailty In Patients With Breast Cancermentioning

confidence: 99%

“…Two prospective studies evaluated whether routine CGA altered breast cancer treatment decisions [41,42] and reported different findings. In the study by Okonji et al, women defined as unfit or frail were less likely to undergo surgery or receive adjuvant chemotherapy [42]. In contrast, Barth el emy et al reported that the CGA results did not influence multi-disciplinary team (MDT) decisions on adjuvant chemotherapy [41].…”

Section: Tools For Identifying Frailty In Patients With Breast Cancermentioning

confidence: 99%

“…First, there was no consistent definition of 'old age', with studies having inclusion criteria that ranged from patients over 65e70 years. Second, there was considerable heterogeneity in the patient populations: six studies only included patients with early breast cancer [37,38,41,43,44] and in two studies, patients with significant cognitive or functional impairment were specifically excluded [40,42]. Finally, there were discrepancies between the studies in the types of individual assessments used to assess CGA domains.…”

Section: Tools For Identifying Frailty In Patients With Breast Cancermentioning

confidence: 99%

“…Whether frailty assessments can provide information to guide decisions on axillary management independent of decisions on primary breast surgery for older patients, is unclear. Few studies specifically address this question, though a multi-centre prospective study using the CGA reported that frailty was not strongly associated with non-receipt of axillary surgery among women who were having primary breast surgery [42].…”

Section: Frailty and Surgical Treatment Planning In Early Breast Cancermentioning

confidence: 99%

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Addressing frailty in patients with breast cancer: A review of the literature

Jauhari

Gannon

Horgan

et al. 2020

European Journal of Surgical Oncology

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a b s t r a c tVarious studies have documented variation in the management of older patients with breast cancer, and some of this variation stems from different approaches to balancing the expected benefit of different treatments, with the ability of patients to tolerate them. Frailty is an emerging concept that can help to make clinical decisions for older patients more consistent, not least by providing a measure of 'biological' ageing. This would reduce reliance on 'chronological' age, which is not a reliable guide for decisions on the appropriate breast cancer care for older patients.This article examines the potential of frailty assessment to inform on breast cancer treatments. Overall, the current evidence highlights various benefits from implementing comprehensive geriatric assessment and screening for frailty in breast cancer patients. This includes a role in supporting the selection of appropriate therapies and improving physical fitness prior to treatment. However, there are challenges in implementing routine frailty assessments in a breast cancer service. Studies have used a diverse array of frailty assessment instruments, which hampers the generalisability of research findings. Consequently, a number of issues need to be addressed to clearly establish the optimal timing of frailty assessment and the role of geriatric medicine specialists in the breast cancer care pathway.

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Association of Chemotherapy With Survival in Elderly Patients With Multiple Comorbidities and Estrogen Receptor–Positive, Node-Positive Breast Cancer

et al. 2020

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IMPORTANCE Breast cancer risk and comorbidities increase with age. Data are lacking on the association of adjuvant chemotherapy with survival in elderly patients with multiple comorbidities and node-positive breast cancer.OBJECTIVE To examine the association of chemotherapy with survival in elderly patients with multiple comorbidities and estrogen receptor-positive, node-positive breast cancer. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study included patients in the US National Cancer Database who were 70 years or older; had a Charlson/Deyo comorbidity score of 2 or 3; had estrogen receptor-positive, ERBB2 (formerly HER2 or HER2/neu)-negative breast cancer; and underwent surgery for pathologic node-positive breast cancer from January 1, 2010, to December 31, 2014. Propensity scores were used to match patients receiving adjuvant chemotherapy with those not receiving adjuvant chemotherapy based on age, comorbidity score, facility type, facility location, pathologic T and N stage, and receipt of adjuvant endocrine and radiation therapy. Data analysis was performed from December 13, 2018, to April 28, 2020. EXPOSURES Chemotherapy. MAIN OUTCOMES AND MEASURESThe association of adjuvant chemotherapy with overall survival was estimated using a double robust Cox proportional hazards regression model. RESULTSOf a total of 2 445 870 patients in the data set, 1592 patients (mean [SD] age, 77.5 [5.5] years; 1543 [96.9%] female) met the inclusion criteria and were included in the initial nonmatched analysis. Of these patients, 350 (22.0%) received chemotherapy and 1242 (78.0%) did not. Compared with patients who did not receive chemotherapy, patients who received chemotherapy were younger (mean age, 74 vs 78 years; P < .001), had larger primary tumors (pT3/T4 tumors: 72 [20.6%] vs 182 [14.7%]; P = .005), and had higher pathologic nodal burden (75 [21.4%] vs 81 [6.5%] with stage pN3 disease and 182 [52.0%] vs 936 [75.4%] with stage pN1 disease; P < .001). More patients who received chemotherapy also received other adjuvant treatments, including endocrine therapy (309 [88.3%] vs 1025 [82.5%]; P = .01) and radiation therapy (236 [67.4%] vs 540 [43.5%]; P < .001). In the matched cohort, with a median follow-up of 43.1 months (95% CI, 39.6-46.5 months), no statistically significant difference was found in median overall survival between the chemotherapy and no chemotherapy groups (78.9 months [95% CI, 78.9 months to not reached] vs 62.7 months [95% CI, 56.2 months to not reached]; P = .13). After adjustment for potential confounding factors, receipt of chemotherapy was associated with improved survival (hazard ratio, 0.67; 95% CI, 0.48-0.93; P = .02).CONCLUSIONS AND RELEVANCE This cohort study found that in node-positive, estrogen receptor-positive elderly patients with breast cancer and multiple comorbidities, receipt of chemotherapy was associated with improved overall survival. Despite attempts to adjust for selection bias, these findings suggest that physicians carefully selected patients likely to derive treat...

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Comprehensive geriatric assessment in 326 older women with early breast cancer

Cited by 32 publications

References 40 publications

Hypofractionated irradiation in 794 elderly breast cancer patients: An observational study

Hypofractionated irradiation in 794 elderly breast cancer patients: An observational study

Addressing frailty in patients with breast cancer: A review of the literature

Association of Chemotherapy With Survival in Elderly Patients With Multiple Comorbidities and Estrogen Receptor–Positive, Node-Positive Breast Cancer

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