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Frailty-Independent Undertreatment Negative Impact on Survival in Older Patients With Breast Cancer

PURPOSE: The management of older adults with breast cancer (BC) remains controversial. The challenging assessment of aging idiosyncrasies and the scarce evidence of therapeutic guidelines can lead to undertreatment. Our goal was to measure undertreatment and assess its impact on survival. METHODS: C...

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Autores principales: Osório, Fernando, Barros, António S., Peleteiro, Bárbara, Barradas, Ana Rita, Urbano, Joana, Fougo, José Luís, Leite-Moreira, Adelino
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Breast Cancer Society 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8724373/
https://www.ncbi.nlm.nih.gov/pubmed/34877829
http://dx.doi.org/10.4048/jbc.2021.24.e45
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author Osório, Fernando
Barros, António S.
Peleteiro, Bárbara
Barradas, Ana Rita
Urbano, Joana
Fougo, José Luís
Leite-Moreira, Adelino
author_facet Osório, Fernando
Barros, António S.
Peleteiro, Bárbara
Barradas, Ana Rita
Urbano, Joana
Fougo, José Luís
Leite-Moreira, Adelino
author_sort Osório, Fernando
collection PubMed
description PURPOSE: The management of older adults with breast cancer (BC) remains controversial. The challenging assessment of aging idiosyncrasies and the scarce evidence of therapeutic guidelines can lead to undertreatment. Our goal was to measure undertreatment and assess its impact on survival. METHODS: Consecutive patients with BC aged 70 years or older were prospectively enrolled in 2014. Three frailty screening tools (G8, fTRST, and GFI) and two functional status scales (Karnofsky performance score and Eastern Cooperative Oncology Group Performance Status) were applied. Disease characteristics, treatment options, and causes of mortality were recorded during a 5-year follow-up. In addition, we defined undertreatment and correlated its survival impact with frailty. RESULTS: A total of 92 patients were included in the study. The median age was 77 (range 70–94) years. The prevalence of frailty was discordant (G8, 41.9%; fTRST, 74.2%; GFI, 32.3%). Only 47.8% of the patients had a local disease, probably due to a late diagnosis (73.9% based on self-examination). Thirty-three patients (35.6%) died, of which 15 were from BC. We found a considerably high proportion (53.3%) of undertreatment, which had a frailty-independent negative impact on the 5-year survival (hazard ratio [HR], 5.1; 95% confidence interval [CI], 2.1–12.5). Additionally, omission of surgery had a frailty-independent negative impact on overall survival (HR, 3.9; 95% CI, 1.9–7.9). CONCLUSION: BC treatment in older adults should be individualized. More importantly, assessing frailty (not to treat) is essential to be aware of the risk-benefit profile and the patient's well-informed willingness to be treated. Undertreatment in daily practice is frequent and might have a negative impact on survival, as we report.
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spelling pubmed-87243732022-01-12 Frailty-Independent Undertreatment Negative Impact on Survival in Older Patients With Breast Cancer Osório, Fernando Barros, António S. Peleteiro, Bárbara Barradas, Ana Rita Urbano, Joana Fougo, José Luís Leite-Moreira, Adelino J Breast Cancer Original Article PURPOSE: The management of older adults with breast cancer (BC) remains controversial. The challenging assessment of aging idiosyncrasies and the scarce evidence of therapeutic guidelines can lead to undertreatment. Our goal was to measure undertreatment and assess its impact on survival. METHODS: Consecutive patients with BC aged 70 years or older were prospectively enrolled in 2014. Three frailty screening tools (G8, fTRST, and GFI) and two functional status scales (Karnofsky performance score and Eastern Cooperative Oncology Group Performance Status) were applied. Disease characteristics, treatment options, and causes of mortality were recorded during a 5-year follow-up. In addition, we defined undertreatment and correlated its survival impact with frailty. RESULTS: A total of 92 patients were included in the study. The median age was 77 (range 70–94) years. The prevalence of frailty was discordant (G8, 41.9%; fTRST, 74.2%; GFI, 32.3%). Only 47.8% of the patients had a local disease, probably due to a late diagnosis (73.9% based on self-examination). Thirty-three patients (35.6%) died, of which 15 were from BC. We found a considerably high proportion (53.3%) of undertreatment, which had a frailty-independent negative impact on the 5-year survival (hazard ratio [HR], 5.1; 95% confidence interval [CI], 2.1–12.5). Additionally, omission of surgery had a frailty-independent negative impact on overall survival (HR, 3.9; 95% CI, 1.9–7.9). CONCLUSION: BC treatment in older adults should be individualized. More importantly, assessing frailty (not to treat) is essential to be aware of the risk-benefit profile and the patient's well-informed willingness to be treated. Undertreatment in daily practice is frequent and might have a negative impact on survival, as we report. Korean Breast Cancer Society 2021-10-20 /pmc/articles/PMC8724373/ /pubmed/34877829 http://dx.doi.org/10.4048/jbc.2021.24.e45 Text en © 2021 Korean Breast Cancer Society https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Osório, Fernando
Barros, António S.
Peleteiro, Bárbara
Barradas, Ana Rita
Urbano, Joana
Fougo, José Luís
Leite-Moreira, Adelino
Frailty-Independent Undertreatment Negative Impact on Survival in Older Patients With Breast Cancer
title Frailty-Independent Undertreatment Negative Impact on Survival in Older Patients With Breast Cancer
title_full Frailty-Independent Undertreatment Negative Impact on Survival in Older Patients With Breast Cancer
title_fullStr Frailty-Independent Undertreatment Negative Impact on Survival in Older Patients With Breast Cancer
title_full_unstemmed Frailty-Independent Undertreatment Negative Impact on Survival in Older Patients With Breast Cancer
title_short Frailty-Independent Undertreatment Negative Impact on Survival in Older Patients With Breast Cancer
title_sort frailty-independent undertreatment negative impact on survival in older patients with breast cancer
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8724373/
https://www.ncbi.nlm.nih.gov/pubmed/34877829
http://dx.doi.org/10.4048/jbc.2021.24.e45
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