P5-23-03: Breast Cancer in Elderly Treatment Algorithm – A New Approach To Optimize the Management of Breast Cancer in Older Patients.

Abstract

Abstract Background: Elderly patients have been receiving a sub-standard treatment for early breast cancer when compared to younger age group patients. A higher percentage of them are being treated with primary endocrine therapy (PET) based on the premise that they may not survive surgery or live long enough to benefit from it. In clinical practice, however, there is no validated assessment in place to assess their surgical risk or estimate their life expectancy. This study aimed to optimize the treatment of early breast cancer in older patients using comprehensive geriatric assessment (CGA). It tested the hypothesis that CGA could be used to predict 2-year survival in older breast cancer patients. Based on that a treatment algorithm was devised which could be used to recommend whether PET or surgery plus endocrine treatment would be best indicated in individual patients. Methods: The study included women >70 years of age with early breast cancer, seen in a dedicated Leicester clinic between 04/2005 and 04/2007. All patients had comprehensive assessment including documentation of co-morbidities, Mini-mental state examination (MMSe), Geriatric depression score (GDS), Activities of daily living (ADL), Instrumental activities of daily living (IADL) and American society of anesthesiologist score (ASA). Analysis was performed to find components of the CGA that were helpful in predicting 2-year survival in these patients. Results: 123 patients were included; age range was 70–94 (median-82). Twenty-two patients died within 2-years. Logistic regression analysis found MMSe, ADL, and ASA score to have an independent association with 2-year survival. A statistically significant correlation (p-value 0.000) was found between the dichotomized combined-score of these components and 2-year survival. Breast Cancer in Elderly Treatment Algorithm (BCETA) was devised using the scores of these three components. Patients who scored one or higher (high-risk group), were found to have <48% two-year survival; those, who scored zero (low-risk group), have >86% chance of two-year survival. The overall accuracy for the algorithm was 81%. Conclusion: Breast Cancer in Elderly Treatment Algorithm is a new and systematic approach to optimize the management of breast cancer in elderly patients. It is helpful in identifying high-risk patients with expected short-survival who may benefit from PET, if their cancer is hormone receptor positive. Patients with predicted longer life expectancy (low-risk) may be recommended standard treatment. A prospective study is ongoing at Leicester research clinic to validate the results. BREAST CANCER IN ELDERLY TREATMENT ALGORITHM Name: Hospital No: DOB: Address: Diagnosis: COMPREHENSIVE GERIATRIC ASSESSMENT TOTAL BCETA SCORE Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-23-03.