Predicting disease-related and patient-reported outcomes in older patients with breast cancer - a systematic review

Willeke G Van Der Plas-Krijgsman,Anna Z De Boer,Pauline De Jong,Esther Bastiaannet,Frederiek Van Den Bos,Simon P Mooijaart,Gerrit Jan Liefers,Johanneke E.A Portielje,Nienke A De Glas

doi:10.1016/j.jgo.2021.01.008

Willeke G Van Der Plas-Krijgsman, Anna Z De Boer + Show 7 more

Open Access

https://doi.org/10.1016/j.jgo.2021.01.008

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Abstract

The number of older patients with breast cancer has increased due to the aging of the general population. The use of a geriatric assessment in this population has been advocated in many studies and guidelines as it can be used to identify high risk populations for early mortality and toxicity. Additionally, geriatric parameters could predict relevant outcome measures. This systematic review summarizes all available evidence on predictive factors for various outcomes (disease-related and survival, toxicity, and patient-reported outcomes), with a special focus on geriatric parameters and patient-reported outcomes, in older patients with breast cancer.Studies were identified through systematic review of the literature published up to September 1st 2019 in the PubMed database and EMBASe. A total of 173 studies were included. Most studies investigated disease-related and survival outcomes (n = 123, 71%). Toxicity was investigated in 40 studies (23%) and a mere 15% (n = 26) investigated patient-reported outcomes. Various measures that can be derived from a geriatric assessment were predictive for survival endpoints. Furthermore, geriatric parameters were among the most frequently found predictors for toxicity and patient-reported outcomes.In conclusion, this study shows that geriatric parameters can predict survival, toxicity, and patient-reported outcomes in older patients with breast cancer. These findings can be used in daily clinical practice to identify patients at risk of early mortality, high risk of treatment toxicity or poor functional outcome after treatment. A minority of studies used relevant outcome measures for older patients, showing the need for studies that are tailored to the older population.

Highlights

The number of older patients with breast cancer has increased due to the aging of the general population [1]
This paper shows that most studies in older patients with breast cancer investigate disease-related and survival outcomes, and only a mere 15% assess patient-reported outcomes (Fig. 5)
This study shows that various geriatric parameters that are derived from a GA can predict survival, toxicity, and patient-reported outcomes in older patients with breast cancer

Summary

Introduction

The number of older patients with breast cancer has increased due to the aging of the general population [1]. Older patients experience less benefit from treatment due to a reduced life expectancy, whereas the risk of treatment toxicity is generally higher [3]. Individual weighing of expected treatment benefits and possible risks could potentially aid in achieving better outcomes in terms of survival and quality of life [4]. This is especially relevant in older patients with breast cancer, many of whom die from other causes than breast cancer [5,6]. Prediction models can provide an individualized risk estimation, yet the existing tools are not tailored to the older population, since they do not take the heterogeneous

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