Adjuvant chemotherapy in elderly patients with early breast cancer. Impact of age and comprehensive geriatric assessment on tumor board proposals

Barthélémy, P.; Heitz, Damien; Mathelin, Carole; Polesi, Hervé; Asmane, Irène; Litique, Valère; Rob, L; Bergerat, Jean‐Pierre; Kurtz, Jean‐Emmanuel

doi:10.1016/j.critrevonc.2010.06.005

Cited by 68 publications

(56 citation statements)

References 14 publications

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“…Oncology studies comparing treatment choices in patients that are considered fit or frail on the basis of a CGA have shown that frail patients receive less intensive treatment or receive no treatment at all [11,12]. Although this shows that standard medical assessment overlaps in part with geriatric assessment, an additional value of the latter is its ability to identify previously unrecognized but potentially modifiable health issues, such as depressive symptoms, cognitive or functional impairment, and malnutrition [4,5,7].…”

Section: Introductionmentioning

confidence: 99%

The Value of Geriatric Assessments in Predicting Treatment Tolerance and All-Cause Mortality in Older Patients With Cancer

Hamaker¹,

et al. 2012

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After completing this course, the reader will be able to:1. Describe the predictive value of geriatric assessments for survival in older cancer patients.2. Describe the predictive value of geriatric assessments for treatment tolerance (such as toxicity of chemotherapy and perioperative complications) in older cancer patients. Explain the concept of frailty compared to individual geriatric conditions.This article is available for continuing medical education credit at CME.TheOncologist.com. CME CME ABSTRACTBackground. Awareness of the use of geriatric assessments for older patients with cancer is increasing. The aim of this review is to summarize all available evidence on the association between geriatric assessments and relevant oncologic outcomes. Method. A systematic search was conducted in Medline and Embase of studies on geriatric assessment in oncology, focusing on the association between baseline assessment and outcome.Results. The literature search identified 2008 reports; 51 publications from 37 studies were selected for inclu-

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Section: Introductionmentioning

confidence: 99%

The Value of Geriatric Assessments in Predicting Treatment Tolerance and All-Cause Mortality in Older Patients With Cancer

Hamaker¹,

et al. 2012

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“…Barthélémy et al [18] concluded that age was the only independent factor associated with a lower rate of adjuvant chemotherapy recommendation in this sample of patients, especially after the age of 80 years. It is suggested that CGA is useful in identifying patients who may be at risk of adverse effects of chemotherapy, but not necessarily identifying those who may benefit from chemotherapy.…”

Section: Resultsmentioning

confidence: 76%

“…A retrospective study in a single center conducted by Barthélémy et al [18] attempted to assess the impact that geriatric assessment, age and other prognostic factors had on treatment proposal of chemotherapy. All patients with early breast cancer ≥70 years discussed by the breast cancer tumor board at the University Hospital of Strasbourg, between July 2006 and July 2009, were considered.…”

Section: Resultsmentioning

confidence: 99%

Comprehensive geriatric assessment for older women with early breast cancer – a systematic review of literature

et al. 2012

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BackgroundThe Comprehensive Geriatric Assessment (CGA) is an analytical tool increasingly implemented in clinical practice. Breast cancer is primarily a disease of older people; however, most evidence-based research is aimed at younger patients.MethodsA systematic review of literature was carried out to assess the use of CGA in older breast cancer patients for clinical decision making. The PubMed, Embase and Cochrane databases were searched.ResultsA total of nine useful full text article results were found. Only five of these were exclusively concerned with early breast cancer; thus, studies involving a variety of cancer types, stages and treatments were accepted, as long as they included early breast cancer.The results comprised a series of low sources of evidence. However, all results shared a common theme: the CGA has a use in determining patient suitability for different types of cancer treatment and subsequently maximizing the patient’s quality of life.ConclusionsThere is not yet sufficient high level evidence to instate CGA guidelines as a mandatory practice in the management of breast cancer, due to the heterogeneity of available studies. More studies need to be conducted to cement current work on the benefits of the CGA. An area of particular interest is with regard to treatment options, especially surgery and chemotherapy, and identifying patients who may be suitable for these treatments.

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“…In a systemic review by Puts et al 2012 [10], four studies, all conducted in France, examined the impact of geriatric assessment on cancer treatment [22,23,24,25]. In two studies, geriatric assessment did not influence the treatment decision, whereas in the other two studies, it led to changes in the treatment plan in 40-50% of patients.…”

Section: Discussionmentioning

confidence: 99%

Chemotherapy Regimen in Nonagenarian Cancer Patients: A Bi-Institutional Experience

Rivoirard¹,

Chargari

Kullab³

et al. 2015

Chemotherapy

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Background: The elderly population in Western countries is growing and constitutes a public health issue. Concomitantly, age-related diseases such as cancer increase. There are few data on the efficacy, tolerability and toxicity of specific anticancer therapy in the very elderly patients; therefore, their management is not standardized. Methods: In this bi-institutional study, we reviewed medical records of patients who received or continued specific anticancer therapy beyond the age of 90 years. Geriatric assessment was not reported for our patients. Twelve patients were enrolled. Their general health condition was good, and half of them were living in elderly institutions. Ten patients had a solid tumor and 2 were treated for hematological malignancies. Most were diagnosed with a locally advanced or metastatic disease, and the goal of treatment was curative for only 1 patient. Six patients received chemotherapy as first-line treatment, 4 patients received targeted therapy and 2 received concomitant chemoradiation. Four patients received a second-line treatment. Results: Despite a significant reduction in treatment posology in half of the patients, 8 acute grade 3/4 toxicities were reported and 2 patients died of treatment-related septic shock. Median duration of first-line treatment was 3.2 months, and progression-free survival ranged from 18 to 311 days. Overall survival ranged from 18 days to 11 years. Conclusion: Aging is a heterogeneous process, and management of elderly patients is a multidisciplinary approach. Geriatric assessment helps to identify older patients with a higher risk of morbidity/mortality and allows to assess the risks and benefits of specific anticancer therapy. The choice of treatment should be based primarily on the expected symptomatic benefit, and treatment should not compromise the quality of life.

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Adjuvant chemotherapy in elderly patients with early breast cancer. Impact of age and comprehensive geriatric assessment on tumor board proposals

Cited by 68 publications

References 14 publications

The Value of Geriatric Assessments in Predicting Treatment Tolerance and All-Cause Mortality in Older Patients With Cancer

The Value of Geriatric Assessments in Predicting Treatment Tolerance and All-Cause Mortality in Older Patients With Cancer

Comprehensive geriatric assessment for older women with early breast cancer – a systematic review of literature

Chemotherapy Regimen in Nonagenarian Cancer Patients: A Bi-Institutional Experience

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