Care of Seniors with Breast Cancer – Treatment Received and Refining Decision Making |
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| Institution: | 1. Canterbury Regional Cancer and Blood Service, Christchurch Hospital, Christchurch, New Zealand;2. University of Otago Christchurch, Department of Medicine, Christchurch Hospital, Christchurch, New Zealand;1. Nuffield Department of Medicine, University of Oxford, Oxford, UK;2. Faculty of Pharmaceutical Sciences, The University of British Columbia, British Columbia, Canada;3. Cardio-Oncology Research Unit, Cardiovascular Analytics Group, Hong Kong, China;4. Department of Medical Oncology, St Bartholomew''s Hospital, London, UK;5. Department of Medical Oncology, University College London Hospital, London, UK;7. Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China;11. Emergency Medicine Unit, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China;12. School of Data Science, City University of Hong Kong, Hong Kong, China;8. Kent and Medway Medical School, Canterbury, UK;1. Department of Pediatrics, Emma Children''s Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands;2. Department of Pediatric Endocrinology, Wilhelmina Children''s Hospital/University Medical Center Utrecht, Utrecht, the Netherlands;3. Laboratory for Experimental Oncology and Radiobiology, Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands;4. Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands;5. Department of Genetics, University Medical Center Utrecht, Utrecht, the Netherlands;7. Department of Oncogenomics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands;11. Department of Pharmaceutical Sciences, University of Utrecht, Utrecht, the Netherlands;1. Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK;2. Royal Marsden Hospital, London, UK;3. Division of Clinical Studies, The Institute of Cancer Research, London, UK;1. Department of Obstetrics and Pediatrics – Azienda Unità Sanitaria Locale – Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Reggio Emilia, Italy;2. Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran;1. Department of Surgical Oncology, BRA-IRCH, All India Institute of Medical Sciences, New Delhi, India;2. Department of Onco-anesthesia & Palliative Medicine, BRA-IRCH, All India Institute of Medical Sciences, New Delhi, India;3. Department of Radiodiagnosis, BRA-IRCH, All India Institute of Medical Sciences, New Delhi, India |
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| Abstract: | AimsTreatment decisions for older patients with breast cancer are complex and evidence is largely extrapolated from younger populations. Frailty and comorbidity need to be considered. We studied the baseline characteristics and treatment decisions in older patients in Christchurch with breast cancer and assessed survival outcomes and prognostic/discriminatory performance of several tools.Materials and methodsWe searched the Canterbury Breast Cancer Registry and identified patients aged 70 years or older at diagnosis with invasive, non-metastatic breast cancer between 1 June 2009 and 30 June 2015. We retrieved demographics, treatment and outcome information. Overall survival and breast cancer-specific survival were estimated. Tools analysing performance status and comorbidity were assessed for their prognostic and discriminatory power.ResultsIn total, 440 patients were identified. Primary surgery was carried out for 362 patients (82.3%): breast-conserving surgery in 114 (of whom 88.6% received radiation therapy); mastectomy in 248 (of whom 24.6% received radiation). Hormone therapy was given for 265 (71.1%) patients with oestrogen receptor-positive cancers. Two hundred and seventy-four (62.3%) patients received full standard treatment, which was associated with significantly improved 5-year survival and 5-year breast cancer-specific survival. The median estimated overall survival was 8.2 years (95% confidence interval 7.3–9.1 years). Of those who died, 71.3% of deaths were due to causes other than breast cancer or unknown causes. The comorbidity-adjusted life expectancy (CALE) showed partial prognostic accuracy. CALE, Charlson and Eastern Cooperative Oncology Group tools all showed discriminatory value.ConclusionIn this population-based series of older patients with breast cancer, showing high levels of primary and adjuvant treatment, patients were more likely to die of causes other than breast cancer. Performance status and comorbidity tools showed prognostic and discriminatory potential in this population supporting their use in treatment decision making. CALE showed the most potential to improve treatment decisions but requires validation in this population to improve prognostic accuracy. |
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| Keywords: | Breast cancer comorbidity performance status seniors therapy |
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