Frailty-independent Undertreatment Negative Impact on Survival in Older Patients With Breast Cancer

Abstract

Introduction: The management of older patients with breast cancer remains controversial. The difficult assessment of ageing idiosyncrasies and the insufficient evidence of therapeutic guidelines can lead to undertreatment. Our goal was to measure undertreatment and assess its impact on survival.Materials and methods: Consecutive patients with breast cancer aged 70 years or older were prospectively enrolled in 2014. Three frailty screening tools (G8, fTRST, GFI) and two functional status scales (KPS, ECOG-PS) were applied. Disease characteristics, treatment options and causes of mortality were recorded in a 5-year follow-up. We defined undertreatment and correlated its survival impact with frailty. Results: A total of 92 patients were included. Median age was 77 (range 70-94) years. The prevalence of frailty was discordant (G8: 41,9%, fTRST: 74.2%, GFI: 32.3%). A low-risk disease was not found (51.2% were N+) probably due to a late diagnosis (76.1% based on self-examination). Thirty-three patients (35.6%) died 15 of them from breast cancer. We found a considerable high proportion (53.3%) of undertreatment, which had a frailty-independent negative impact on 5-year survival (HR=5.1 [95% CI: 2.1-12.5]). Additionally, omission of surgery had a frailty-independent negative impact on overall survival (HR=3.9 [95% CI: 1.9-7.9]). Conclusion: Breast cancer treatment in older adults ought to be individualized. More important than assessing frailty (not to treat) is essential to be aware of the risk-benefit profile and the patient's well-informed willingness to be treated. The undertreatment in daily practice is frequent and might have, as we report, a negative impact on survival.