Observational cohort study in older women with early breast cancer: Use of radiation therapy and impact on health-related quality of life and mortality

Battisti, Nicolò Matteo Luca; Hatton, Matthew; Reed, Malcolm; Herbert, Esther; Morgan, Jenna; Bradburn, Michael; Simcock, Richard; Walters, Stephen J.; Collins, Karen; Ward, Sue; Holmes, Geoffrey R.; Burton, Maria; Lifford, Kate; Edwards, Adrian; Robinson, Thompson G.; Martin, Charlene; Chater, Tim; Pemberton, Kirsty; Brennan, Alan; Cheung, Kwok-Leung; Todd, Annaliza; Audisio, Riccardo A.; Wright, Juliet; Green, Tracy; Revell, Deirdre; Gath, Jacqui; Horgan, Kieran; Holcombe, Chris; Winter, M.C.; Naik, Jay; Parmeshwar, Rishi; Gosney, Margot; Thompson, Alastair; Wyld, Lynda; Ring, Alistair

doi:10.1016/j.radonc.2021.06.021

Cited by 13 publications

(11 citation statements)

References 50 publications

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“…In addition to survival outcomes, radiotherapy-related toxicity and quality of life effects [42] are important endpoints to assess among older patients receiving radiotherapy. In a prospective multicentre cohort study of women aged 70 years and over with early breast cancer, with comprehensive measures of fitness and frailty, radiotherapy after BCS or mastectomy had an initial but temporary impact on quality of life [43]. This finding was reflected in a single institution analysis of women aged 70 years and over who received surgery (BCS or mastectomy) and postoperative radiotherapy, which suggested that age did not have an impact on radiotherapy-related toxicity [44].…”

Section: Discussionmentioning

confidence: 98%

The Association Between Survival and Receipt of Post-mastectomy Radiotherapy According to Age at Diagnosis Among Women With Early Invasive Breast Cancer: A Population-Based Cohort Study

Miller¹,

Gannon²,

Medina³

et al. 2023

Clinical Oncology

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Section: Discussionmentioning

confidence: 98%

The Association Between Survival and Receipt of Post-mastectomy Radiotherapy According to Age at Diagnosis Among Women With Early Invasive Breast Cancer: A Population-Based Cohort Study

Miller¹,

Gannon²,

Medina³

et al. 2023

Clinical Oncology

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“… 49 However, high rates of radiation therapy use are still observed, although there is high variability according to geographical region. 10 , 75 Results from the Bridging the Age Gap group show that radiation therapy use in the adjuvant setting is largely determined by patient age and the clinician’s observed risk of recurrence and, interestingly, less driven by geriatric assessment. 75 Overall, radiation therapy was well tolerated by older women, with only a transient decrease in quality of life.…”

Section: Clinical Trends In De-implementation In Low-risk Breast Cancer In Older Womenmentioning

confidence: 99%

“… 10 , 75 Results from the Bridging the Age Gap group show that radiation therapy use in the adjuvant setting is largely determined by patient age and the clinician’s observed risk of recurrence and, interestingly, less driven by geriatric assessment. 75 Overall, radiation therapy was well tolerated by older women, with only a transient decrease in quality of life. Even with tolerability, adjuvant radiation therapy can safely be de-escalated in older women in this setting; higher-grade or higher-stage tumours in the setting of cN0 disease do not increase the risk of recurrence.…”

Section: Clinical Trends In De-implementation In Low-risk Breast Cancer In Older Womenmentioning

confidence: 99%

Personalising therapy for early-stage oestrogen receptor-positive breast cancer in older women

Carleton

Nasrazadani

Gade

et al. 2022

The Lancet Healthy Longevity

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Age is one of the most important risk factors for the development of breast cancer. Nearly a third of all breast cancer cases occur in older women (aged ≥70 years), with most cases being oestrogen receptor-positive (ER+). Such tumours are often indolent and unlikely to be the ultimate cause of death for older women, particularly when considering other comorbidities. This Review focuses on unique clinical considerations for screening, detection, and treatment regimens for older women who develop ER+ breast cancers—specifically, we focus on recent trends for de-implementation of screening, staging, surgery, and adjuvant therapies along the continuum of care. Additionally, we also review emerging basic and translational research that will further uncover the unique underlying biology of these tumours, which develop in the context of systemic age-related inflammation and changing hormone profiles. With prevailing trends of clinical de-implementation, new insights into mechanistic biology might provide an opportunity for precision medicine approaches to treat patients with well tolerated, low-toxicity agents to extend patients’ lives with a higher quality of life, prevent tumour recurrences, and reduce cancer-related burdens.

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“…Most observational studies evaluating fatigue in breast cancer patients have been cross‐sectional studies that focused on acute fatigue, with assessments up to 6 months after treatment completion. Only a small proportion evaluated CRF beyond 6 months and, from those, even fewer focused on RT‐treated patients 8‐11 . More than 20 different instruments have been employed to evaluate CRF, contributing to a large heterogeneity in its measurement 12 .…”

Section: Introductionmentioning

confidence: 99%

“…Only a small proportion evaluated CRF beyond 6 months and, from those, even fewer focused on RT-treated patients. [8][9][10][11] More than 20 different instruments have been employed to evaluate CRF, contributing to a large heterogeneity in its measurement. 12 Most studies used single-items or unidimensional rather than multidimensional questionnaires and were therefore unable to capture the multidimensional aspect of fatigue with its distinct fatigue dimensions (eg, mental, physical or emotional fatigue).…”

Section: Introductionmentioning

confidence: 99%

(Pre)treatment risk factors for late fatigue and fatigue trajectories following radiotherapy for breast cancer

Rosas

Aguado-Barrera

Azria

et al. 2023

Intl Journal of Cancer

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Fatigue is common in breast‐cancer survivors. Our study assessed fatigue longitudinally in breast cancer patients receiving adjuvant radiotherapy (RT) and aimed to identify risk factors associated with long‐term fatigue and underlying fatigue trajectories. Fatigue was measured in a prospective multicenter cohort (REQUITE) using the Multidimensional Fatigue Inventory (MFI‐20) and analyzed using mixed models. Multivariable logistic models identified factors associated with fatigue dimensions at 2 years post‐RT and latent class growth analysis identified individual fatigue trajectories. A total of 1443, 1302, 1203 and 1098 patients completed the MFI‐20 at baseline, end of RT, after 1 and 2 years. Overall, levels of fatigue significantly increased from baseline to end of RT for all fatigue dimensions (P < .05) and returned to baseline levels after 2 years. A quarter of patients were assigned to latent trajectory high (23.7%) and moderate (24.8%) fatigue classes, while 46.3% and 5.2% to the low and decreasing fatigue classes, respectively. Factors associated with multiple fatigue dimensions at 2 years include age, BMI, global health status, insomnia, pain, dyspnea and depression. Fatigue present at baseline was consistently associated with all five MFI‐20 fatigue dimensions (ORGeneralFatigue = 3.81, P < .001). From latent trajectory analysis, patients with a combination of factors such as pain, insomnia, depression, younger age and endocrine therapy had a particularly high risk of developing early and persistent high fatigue years after treatment. Our results confirmed the multidimensional nature of fatigue and will help clinicians identify breast cancer patients at higher risk of having persistent/late fatigue so that tailored interventions can be delivered.

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Observational cohort study in older women with early breast cancer: Use of radiation therapy and impact on health-related quality of life and mortality

Cited by 13 publications

References 50 publications

The Association Between Survival and Receipt of Post-mastectomy Radiotherapy According to Age at Diagnosis Among Women With Early Invasive Breast Cancer: A Population-Based Cohort Study

The Association Between Survival and Receipt of Post-mastectomy Radiotherapy According to Age at Diagnosis Among Women With Early Invasive Breast Cancer: A Population-Based Cohort Study

Personalising therapy for early-stage oestrogen receptor-positive breast cancer in older women

(Pre)treatment risk factors for late fatigue and fatigue trajectories following radiotherapy for breast cancer

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