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Predicting fatigue in older breast cancer patients receiving radiotherapy

A head-to-head comparison of established assessments

Kann man die Entwicklung einer Fatigue bei älteren Patientinnen mit Mammakarzinom und Radiotherapie vorhersagen?

Ein direkter Vergleich etablierter Bewertungsverfahren

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Abstract

Objectives

Because of substantial toxicities in older adults, chemotherapy is often omitted while the frequency of radiotherapy changes only minimally. In this study, we addressed the value of different assessments for predicting fatigue after radiotherapy in older breast cancer patients.

Patients and methods

We included 74 women with primary breast cancer over the age of 65 years treated with radiotherapy (26 % with additional chemotherapy). Assessments were conducted before adjuvant treatment and after radiotherapy. The assessments included the Vulnerable Elders Survey (VES-13), the Karnofsky Performance Status (KPS), the EORTC Quality of Life assessment (EORTC-QLQ-C30), a cancer-specific comprehensive geriatric assessment (cancer-specific CGA), and the Fried frailty score. Multiple linear regression analyses were used to assess correlations with the FACIT-fatigue scale.

Results

Patients were on average 71 years old (range, 65–86 years). Most tumors (n=62) were classified as intermediate risk according to the St. Gallen consensus. The cancer-specific CGA was best associated with fatigue (p < 0.001, β estimate = 1.75), followed by the Fried frailty score (for the score of 1 versus reference of 2 and higher: p = 0.035, β estimate = − 5.74). There were no significant ceiling effects but there were substantial floor effects for the VES-13, KPS, and frailty score.

Conclusion

The cancer-specific CGA and the Fried frailty score (driven mainly by the item “exhaustion”) outperformed the other indices in predicting fatigue in a group of rather well-functioning older women with primary breast cancer.

Zusammenfassung

Ziele

Ältere Krebspatienten bekommen seltener eine Chemotherapie, die Häufigkeit der Radiotherapie ändert sich dagegen kaum. In dieser Studie haben wir die Wertigkeit verschiedener Assessmentinstrumente bezüglich ihrer Vorhersagekapazität für Fatigue in einer Gruppe älterer Brustkrebspatientinnen untersucht.

Patienten und Methoden

Wir schlossen 74 Frauen mit primärem Mammakarzinom und älter als 65 Jahre ein, die mit Radiotherapie behandelt wurden. 26 % erhielten zusätzlich eine adjuvante Chemotherapie. Die Assessments wurden vor Beginn der adjuvanten Behandlung und nach der Radiotherapie durchgeführt. Die untersuchten Assessments waren der Vulnerable Elders Survey (VES), der Karnofsky Status (KPS), das EORTC Quality of Life Assessment (EORTC-QLQ-C30), ein Tumor-spezifisches Geriatrisches Assessment (Cancer-specific CGA nach A. Hurria) und der Frailty score (nach L. Fried).

Ergebnisse

Die Patientinnen waren im Mittel 71 Jahre alt (65–86 Jahre). Das Tumorstadium wurde zum größten Teil (n = 62) als intermediäres Risiko nach dem St. Gallen Konsensus eingestuft. Der Tumor-spezifische CGA war am besten mit Fatigue assoziiert (p< 0,001, β-Schätzer = 1,75), gefolgt von dem Fried Frailty Score (Für den Wert 1 gegenüber der Referenz von 2 und mehr Punkten: p = 0,035, β-Schätzer = − 5,74). Während keine signifikanten Deckeleffekte festgestellt werden konnten, gab es deutliche Bodeneffekte beim VES-13, dem KPS und dem Frailty Score.

Schlussfolgerung

In unserer Studie bei körperlich eher fitten, älteren Patientinnen mit Mammakarzinom und nachfolgender Radiotherapie waren das Tumor-spezifische CGA nach A. Hurria und der Frailty Score nach L. Fried (vor allem bedingt durch den Punkt „Erschöpfung“) den anderen Indizes hinsichtlich ihrer Vorhersagekapazität für Fatigue überlegen.

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Acknowledgments

Michael Denkinger was supported by a geriatric research grant from the Robert Bosch Foundation, Stuttgart, Germany, which did not have any influence on the content. The authors would like to thank all patients that agreed to participate in this project with time-consuming interviews.

Prof. Thorsten Nikolaus, Chair for Geriatric Medicine at Ulm University and Director of the AGAPLESION Bethesda Hospital Ulm, passed away 26 September 2013. He will be warmly remembered and dearly missed by all.

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Authors and Affiliations

  1. AGAPLESION Bethesda Klinik Ulm, Geriatrie der Universität Ulm, Zollernring 26, 89073, Ulm, Deutschland

    Michael Dieter Denkinger MD & Thorsten Nikolaus MD

  2. Geriatrisches Zentrum Ulm/Alb-Donau, Zollernring 26, 89073, Ulm, Deutschland

    Michael Dieter Denkinger MD & Thorsten Nikolaus MD

  3. Universitätsfrauenklinik Ulm, Prittwitzstr. 43, 89075, Ulm, Deutschland

    Melanie Hasch, Anna Gerstmayer, Rolf Kreienberg MD & Katharina Hancke MD

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  1. Michael Dieter Denkinger MD
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Correspondence to Michael Dieter Denkinger MD.

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Conflict of interest

M.D. Denkinger, M. Hasch, A. Gerstmayer, R. Kreienberg, T. Nikolaus, and K. Hancke state that there are no conflicts of interest.

There are no financial disclosures to be declared. The foundation did not have any role in the analysis of data and decision to publish.

The study protocol was approved by the University of Ulm Medical School Ethics Committee and written informed consent was obtained from all participants.

All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

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Denkinger, M., Hasch, M., Gerstmayer, A. et al. Predicting fatigue in older breast cancer patients receiving radiotherapy. Z Gerontol Geriat 48, 128–134 (2015). https://doi.org/10.1007/s00391-014-0840-5

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  • DOI: https://doi.org/10.1007/s00391-014-0840-5

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