A pilot study to examine the feasibility of personalizing treatment options of elderly breast cancer patients through individual risk profiling

Abstract

Background: Decision for the best optimal treatment for the elderly is always a challenge, in particular when deciding for surgery. Studies have showed for frail elderly with limited life expectancy, primary endocrine therapy alone may be appropriate with equivalent survival. Those patients with longer life expectancy could have survival gain from surgery. A comprehensive geriatric assessment (CGA) would be useful to predict the survival probability and guide the optimal treatment. Methods: Consecutive new patients aged 70 or above with a diagnosis of stage I to III breast cancer, were recruited from July to December 2017. The decision of treatment was independently made regardless of the study assessment. A prospective cross-sectional study using CGA was conducted. Scoring for each component of CGA was measured and the correlation with the treatment was analysed. Results: Twenty-four patients were recruited during the study period. Nineteen of them received surgical treatment whereas five received non-surgical treatment. Older age (p = 0.010), higher Eastern Cooperative Oncology Group (ECOG) score (p = 0.028), higher degree of dependence by the instrumental activities of daily living (p = 0.018), cognitive impairment by the Hong Kong version of montreal cognitive assessment (HK-MoCA) (p = 0.006), and very high Charlson comorbidity index (> 5) (p =0.047) were significantly related to non-surgical treatment. Conclusion: This pilot study confirmed the feasibility in conducting CGA to personalize treatment options for older breast cancer patients. A larger prospective trial is ongoing to validate the impact of each CGA domain in relation to the treatment outcome. Copyright © 2021, Taiwan Society of Geriatric Emergency & Critical Care Medicine.