Abstract
IntroductionSince older patients with breast cancer are underrepresented in clinical trials, an oncogeriatric approach is advocated to guide treatment decisions. However, the effect on outcomes is unclear. The aim of this study was to compare treatments and outcomes between patients treated in an oncogeriatric and a standard care setting.MethodsPatients aged ≥ 70 years with early stage breast cancer were included. The oncogeriatric cohort comprised unselected patients from the Moffitt Cancer Center, and the standard cohort patients from a Dutch population-based cohort. Cox models were used to characterize the influence of care setting on recurrence risk and overall mortality.ResultsOverall, 268 patients were included in the oncogeriatric and 1932 patients in the standard cohort. Patients in the oncogeriatric cohort were slightly younger, had more comorbidity, and received more adjuvant endocrine therapy and chemotherapy. Oncogeriatric care was associated with a lower risk of recurrence, which remained significant after adjustment for patient and tumour characteristics [hazard ratio (HR) 0.66, 95% confidence interval (CI) 0.44–0.99]. Oncogeriatric care was also associated with a lower overall mortality, which also remained significant after adjustment for patient and tumour characteristics (HR 0.69, 95% CI 0.55–0.87).ConclusionsPatients treated in the oncogeriatric care setting had a lower risk of recurrence, which may be explained by more systemic treatment. Overall mortality was also lower, but other explanations besides care setting could not be ruled out as the cohorts had different patient profiles. Future studies need to clarify the impact of an oncogeriatric approach on outcomes.
Highlights
Since older patients with breast cancer are underrepresented in clinical trials, an oncogeriatric approach is advocated to guide treatment decisions
Oncogeriatric care was associated with a lower risk of recurrence (HR 0.67, 95% confidence interval (CI) 0.46–0.98), which remained significant after adjustment for patient and tumour characteristics
Oncogeriatric care was associated with a lower overall mortality (HR 0.66, 95% CI 0.54–0.80), which remained significant after adjustment for patient and tumour characteristics (HR 0.69, 95% CI 0.55–0.87)
Summary
Since older patients with breast cancer are underrepresented in clinical trials, an oncogeriatric approach is advocated to guide treatment decisions. The aim of this study was to compare treatments and outcomes between patients treated in an oncogeriatric and a standard care setting. Oncogeriatric care was associated with a lower risk of recurrence, which remained significant after adjustment for patient and tumour characteristics [hazard ratio (HR) 0.66, 95% confidence interval (CI) 0.44–0.99]. Oncogeriatric care was associated with a lower overall mortality, which remained significant after adjustment for patient and tumour characteristics (HR 0.69, 95% CI 0.55–0.87). Conclusions Patients treated in the oncogeriatric care setting had a lower risk of recurrence, which may be explained by more systemic treatment. In order to guide treatment decisions in the heterogeneous population of older patient with breast cancer, the International Society of Geriatric Oncology (SIOG) and European Society of Breast Cancer Specialists
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