Personalised treatment for older patients with breast cancer: what determines the survival outcome?

Abstract

Aim: Treatment of elderly patients with operable breast cancer requires a multi‐disciplinary approach to match the medical needs specific to the geriatric population. We investigated the clinical and pathological determinants in an elderly population with localized breast cancer to identify the prognostic factors for survival. Methods: Chinese patients aged 70 and above with non‐metastatic breast cancer treated between 2008 and 2017 at a University‐affiliated tertiary breast centre were reviewed. Clinical‐pathological factors as well as patients’ premorbidity predicting overall survival were analysed using univariate and multivariate cox proportional hazard model. Results: 347 patients fulfilled the inclusion criteria for analysis. Our cohort had a median overall survival of 10.7 years. When stratified by TNM staging, overall survival was 11.29, 10.13, and 4.36 years for stage I, II and III respectively. Univariate analysis identified advanced age, high Charlson Comorbidity Index, American Society of Anesthesiologists score of 3, dependent functional status, larger tumor size, advanced lymph node status, histological high grade, and those who underwent primary endocrine therapy alone to be associated with increased risk of mortality. Multivariate analysis showed that only Charlson Comorbidity Index had a significant effect on survival probabilities, after adjusting for other variables. Those patients with more comorbidities (higher Charlson Comorbidity Index) predicted increased risk of death compared with those without comorbidities in this elderly cohort (HR = 3.411; 95% CI 1.515‐7.681, P = .003). Conclusions: Fragility determines survival outcomes in older breast cancer patients. There is a need for comprehensive geriatric assessment in personalizing treatment options in this population to optimise survival outcomes.