Patient-Reported Outcomes in Geriatric Oncology-Balancing Quality of Life and Therapeutic Effectiveness Using Primary Breast Cancer as a Model.

Abstract

Breast cancer remains the most prevalent cancer worldwide, necessitating advancements in its management. Surgery remains the recommended primary treatment although neoadjuvant or adjuvant treatments, such as chemotherapy, may also be indicated. However, such medications confer a risk of toxicity, often resulting in dose reductions and hospitalisations. This morbidity is particularly pertinent within older patients, for whom their experience of breast cancer is already faced through the lens of unique challenges often including comorbidity, socioeconomic decline and limited support networks. Quality of life (QoL) assessments acknowledge the impact of diagnosis and treatment on patients' psychological, emotional and physical well-being. Multiple tools exist (each with their own strengths and weaknesses) ranging from the more comprehensive [such as the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30)] to the more broadly focused [including the General Functional Assessment of Cancer Therapy (FACT-G)]. However, while such tools have existed for some time, there remains a gap in clinical guidance as to their integration, particularly within older patient cohorts. This article seeks to address these complexities in breast cancer decision-making by exploring how QoL assessment can best be utilised inform efficacy-tolerability trade-offs, and subsequently facilitate optimal patient-centred care.