Abstract
PurposeThere is an ongoing discussion about ‘undertreatment’ of breast cancer in elderly patients. Due to low accrual into clinical trials, level 1 evidence is scarce. We report prospective data of elderly patients with breast cancer treated by medical oncologists in Germany.MethodsThe SENORA project within the prospective cohort study TMK (Tumour Registry Breast Cancer) was conducted in 82 centres from 2007–2015. Among 2316 patients, half were enrolled with curative and half with palliative treatment intention. Overall, 478 patients (21%) were aged ≥ 70.ResultsIn the adjuvant setting, elderly patients aged ≥ 70 had more advanced tumour stages at diagnosis and a higher prevalence of comorbidities than younger patients. Elderly patients received adjuvant chemotherapy less frequently, yet the 3-year disease-free survival was similar (86% vs. 88%). In the palliative setting, elderly patients more frequently received endocrine therapy and less frequently chemotherapy. Their median overall survival [24.9 months, 95% CI (confidence interval) 20.0–30.2] was significantly shorter than that of younger patients (39.7 months, 95% CI 34.9–44.2). A Cox proportional hazards model showed a significantly increased risk of mortality for: age ≥ 70 at start of therapy, negative HR- or HER2-status, higher number of metastatic sites, more comorbidities and high tumour grading at diagnosis.ConclusionsOur results shed light on the routine treatment of elderly patients with breast cancer. A regression model demonstrated that age is but one of various prognostic factors determining the shorter overall survival of elderly patients.
Highlights
We present the disease-free survival (DFS) as well as the overall survival (OS) for both younger and elderly patients and present a multivariate regression model identifying factors influencing the OS
The following independent variables were examined for the model: age at start of first-line treatment, body mass index (BMI) at enrolment, Charlson comorbidity index, Charlson Comorbidity Index (CCI) [23] at diagnosis, HR-status and HER2-status at diagnosis, stage and tumour grading at diagnosis as well as resection of the primary tumour
Basic demographic and clinical data of the patients receiving adjuvant therapy are presented in Table 1, comparing patients younger than 70 years to those aged ≥ 70
Summary
In Germany, breast cancer is the most frequently diagnosed cancer (31% of all cases), with women aged 70 or older at diagnosis representing 34% of these cases [1, 2]. For the prospectively enrolled patients with palliative treatment intention (maximum span of 6 weeks between start of treatment and signed informed consent), a Cox proportional hazards model was used to identify potential independent prognostic factors for survival. The following independent variables were examined for the model: age at start of first-line treatment, body mass index (BMI) at enrolment, Charlson comorbidity index, CCI [23] at diagnosis, HR-status and HER2-status at diagnosis, stage and tumour grading at diagnosis as well as resection of the primary tumour These treatment details at start of first-line therapy were included: prior neoadjuvant or adjuvant chemotherapy; number of metastatic sites and location of metastases.
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