Does multidimensional geriatric assessment influence the prescription of adjuvant chemotherapy to elderly women with early breast cancer in a multivariate model?

Abstract

20541 Background: To evaluate in a multivariate model if the outcome of Multidimensional Geriatric Assessment (MGA) influences the prescription of adjuvant chemotherapy (as a binary outcome) to elderly women with intermediate-high risk early breast cancer enrolled in a observational, prospective, multicenter study. Methods: MGA was performed at first diagnosis [Basso Eur J Cancer Care 2004] and pts were classified as Frail if ADLs dependent or with three or more severe comorbidities, or with one or more geriatric syndromes, or ≥85 years. Pts without relevant comorbidities and fully independent were classified as Fit and pts with only one or two significant comorbid conditions, or only IADLs but no ADLs deficit, as Vulnerable [Balducci Cancer Control 2001]. Results: Out of 195 pts so far enrolled, 148 had at least one risk factor (T≥ 2 cm, positive lymph nodes, tumor grade G2 or G3, Estrogen receptor-ER negative) and were eligible for this study. Median age was 76 years (range, 70–91.5). After MGA, 32.5% were deemed Fit, 38.5% Vulnerable and 29% Frail. Chemotherapy was prescribed to 30 pts (20.3%). Univariate analysis demonstrated a correlation of chemotherapy with age <80 years, node positive, and ER negative disease. Outcome of MGA was not significant either comparing the choice in Fit vs non-Fit patients (OR for fit =1.27) or Frail vs not-Frail patients (OR for frailty=1.06) (table 1). We then assessed the same factors in a backward multivariate model. Age < 80 years, N positive and ER- retained prognostic relevance, while outcome at MGA did not appear to correlate with chemotherapy. Conclusions: Older breast cancer women are evenly distributed among the three classes of elderly patients but MGA does not appear to impact on the choice for chemotherapy either because biological factors are perceived to be more relevant or because current criteria of frailty and ’fitness’ do not coincide with clinical parameters used by Oncologists for this therapeutic choice. OR for prescription of chemotherapy 95% CI Age < 80 years 5.75 1.65–20.05 Positive lymph nodes 8.67 3.45–21.8 ER negative 10.36 2.87–37.4 T ≥ 2 cm 1.8 0.79–4.07 G2 or G3 0.5 0.08–2.87 Fit at MGA 1.27 0.55–2.93 Frail at MGA 1.06 0.45–2.55 No significant financial relationships to disclose.