Survival Outcome and Predictors of Survival in Elderly Breast Cancer Patients following Curative Treatment

 

 Permissions and Reprints

Abstract

Objectives The lack of data on management of elderly breast cancer patients' population makes most oncologists reluctant to treat them with the standard treatment protocols as advised for the younger patients. This study was done to identify the survival outcome and predictors of survival in elderly breast cancer patients treated with curative intent.

Materials and Methods Newly diagnosed patients with breast cancer aged more than 65 years who received treatment with curative intent were included. Disease-free survival (DFS) and overall survival were estimated using the Kaplan–Meier method. Survival curves were compared using log-rank test. Cox regression analysis was done to find out the predictors of DFS.

Results This study included 112 elderly breast cancer patients. In our patient population, 79 (70.5%) were less than or equal to 70 years of age and 33 (29.5%) were more than or equal to 70 years. Median age was 68 years. Charlson comorbidity index score was six and above in 31 (28.1) patients. Median DFS in our study was 46 months. Median DFS was not reached in patients less than or equal to 70 years of age, whereas it was 50 months (47–53) among patients more than or equal to 70 years of age, p-value-0.009. In univariate analysis, age more than or equal to 70 years and locally advanced breast cancer were the predictors of DFS with hazard ratio (HR) of 2.8 (1.2–6.69), p-value 0.013 and 2.9 (1.12–7.6), and 0.027, respectively. In multivariate analysis, age more than or equal to 70 years was the only significant predictors of DFS with HR of 2.8 (1.2–6.5) and p-value of 0.015.

Conclusion Standard curative intent treatment was well tolerable among elderly patents. Elderly age more than 70 years was a unique predictor of DFS. We need to incorporate tools to assess life expectancy and functional status that will help us predict toxicity of treatment and survival advantage more precisely.

Note

The abstract of this study was accepted @ESMO abstracts, 2021 conference and published in ESMO abstract only supplement. DOI: https://doi.org/10.1016/j.annonc.2021.08.508.

Authors' Contributions

TM Anoop designed the study, drafted the manuscript, supervised the study, and treatment; Rona Joseph P participated in the design, supervision of the study, and treatment; Rajeev KR participated in the design, supervision of the study, and treatment; Steffi Chacko participated in the design of the study; Saikumar involved statistical analysis; Mintu Mathew participated in data collection; all authors read and approved the final manuscript. Bhavya S kumar involved data collection and statistical analysis.

Publication History

Article published online:
11 August 2023

© 2023. MedIntel Services Pvt Ltd. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

• Reference

• 1 Varghese F, Wong J. Breast cancer in the elderly. Surg Clin North Am 2018; 98 (04) 819-833
  CrossrefPubMedGoogle Scholar
• 2 Bertolo A, Rosso C, Voutsadakis IA. Breast cancer in patients 80 years-old and older. Eur J Breast Health 2020; 16 (03) 208-212
  CrossrefPubMedGoogle Scholar
• 3 Biganzoli L, Battisti NML, Wildiers H. et al. Updated recommendations regarding the management of older patients with breast cancer: a joint paper from the European Society of Breast Cancer Specialists (EUSOMA) and the International Society of Geriatric Oncology (SIOG). Lancet Oncol 2021; 22 (07) e327-e340
  CrossrefPubMedGoogle Scholar
• 4 Lodi M, Scheer L, Reix N. et al. Breast cancer in elderly women and altered clinico-pathological characteristics: a systematic review. Breast Cancer Res Treat 2017; 166 (03) 657-668
  CrossrefPubMedGoogle Scholar
• 5 Reddy A, Mullapudi NA, Kabeer KK, Nimmagadda R, Radhakrishna S. Treatment of elderly breast cancer patients in a breast center in India. Indian J Cancer 2019; 56 (01) 45-49
  CrossrefPubMedGoogle Scholar
• 6 Muss HB, Polley MC, Berry DA. et al. Randomized trial of standard adjuvant chemotherapy regimens versus capecitabine in older women with early breast cancer: 10-year update of the CALGB 49907 trial. J Clin Oncol 2019; 37 (26) 2338-2348
  CrossrefPubMedGoogle Scholar
• 7 Ma SJ, Oladeru OT, Singh AK. Outcome of adjuvant chemotherapy in elderly patients with early-stage, hormone receptor-positive, HER-2-negative breast cancer. Breast J 2020; 26 (10) 2026-2030
  CrossrefPubMedGoogle Scholar
• 8 Rocque GB, Williams CP, Andrews C. et al. Patient perspectives on chemotherapy de-escalation in breast cancer. Cancer Med 2021; 10 (10) 3288-3298
  CrossrefPubMedGoogle Scholar
• 9 Maltoni R, Ravaioli S, Bronte G. et al. Chronological age or biological age: what drives the choice of adjuvant treatment in elderly breast cancer patients?. Transl Oncol 2022; 15 (01) 101300
  CrossrefPubMedGoogle Scholar
• 10 Yamada A, Narui K, Sugae S. et al. Operation with less adjuvant therapy for elderly breast cancer. J Surg Res 2016; 204 (02) 410-417
  CrossrefPubMedGoogle Scholar
• 11 Tamirisa N, Lin H, Shen Y. et al. Association of chemotherapy with survival in elderly patients with multiple comorbidities and estrogen receptor-positive, node-positive breast cancer. JAMA Oncol 2020; 6 (10) 1548-1554
  CrossrefPubMedGoogle Scholar

• Supplementary Material