Comorbidity, disability and geriatric syndromes in elderly breast cancer survivors. Results of a single-center experience

Gironés, Regina; Torregrosa, Dolores; Díaz‐Beveridge, Roberto

doi:10.1016/j.critrevonc.2009.08.002

Cited by 63 publications

(62 citation statements)

References 30 publications

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“…The use of score tables established in geriatric medicine provides additional information to performance status: 9%-38% of elderly patients with good performance status (Ͻ 2) were partially or fully dependent on others to carry out ordinary activities, such as household tasks and personal care. 15,16 …”

Section: Effect Of Vulnerability On Cancer Outcome In Elderly Patientsmentioning

confidence: 99%

Personalized therapy in multiple myeloma according to patient age and vulnerability: a report of the European Myeloma Network (EMN)

Palumbo

Bringhen

Ludwig

et al. 2011

Blood

312

213

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Most patients with newly diagnosed multiple myeloma (MM) are aged > 65 years with 30% aged > 75 years. Many elderly patients are also vulnerable because of comorbidities that complicate the management of MM. The prevalence of MM is expected to rise over time because of an aging population. Most elderly patients with MM are ineligible for autologous transplantation, and the standard treatment has, until recently, been melphalan plus prednisone. The introduction of novel agents, such as thalidomide, bortezomib, and lenalidomide, has improved outcomes; however, elderly patients with MM are more susceptible to side effects and are often unable to tolerate full drug doses. For these patients, lower-doseintensity regimens improve the safety profile and thus optimize treatment outcome. Further research into the best treatment strategies for vulnerable elderly patients is urgently needed. Appropriate screening for vulnerability and an assessment of cardiac, pulmonary, renal, hepatic, and neurologic functions, as well as age > 75 years, at the start of therapy allows treatment strategies to be individualized and drug doses to be tailored to improve tolerability and optimize efficacy. Similarly, occurrence of serious nonhematologic adverse events during treatment should be carefully taken into account to adjust doses and optimize outcomes. IntroductionMultiple myeloma (MM) is a malignant disease characterized by uncontrolled plasma tumor cell proliferation, driven by intrinsic chromosomal abnormalities and extrinsic stromal cell support, together with the presence of monoclonal protein in the blood or urine or both. 1,2 Typical clinical presentation at diagnosis includes anemia (commonly presenting as fatigue), skeletal lesions (presenting as bone pain), renal impairment, and hypercalcemia. In Western countries, the annual age-adjusted incidence of MM is 5.6 cases per 100 000 people. The median patient age at diagnosis is ϳ 70 years; only 37% of patients with newly diagnosed (ND) disease are aged Ͻ 65 years, 26% are aged 65-74 years, and 37% are aged Ն 75 years. 3 The annual prevalence of MM in patients aged 65-74 years is ϳ 31 cases per 100 000 people, and it increases to 46 cases per 100 000 people in patients aged Ն 75 years. Furthermore, the number of elderly patients with MM will probably increase because of the improved survival times that are associated with novel agents coupled with the increasing life expectancy of the general population.In recent years, the introduction of novel agents such as thalidomide, lenalidomide, and the proteasome inhibitor bortezomib, which are associated with high-dose therapy and autologous stem cell transplantation in young patients and standard chemotherapy in elderly patients, has changed the management of myeloma and extended overall survival (OS) times. [4][5][6][7] An estimate of the 5-year relative survival of patients with MM in the United States from 1990States from -1992States from to 2002States from -2004 reported a significant survival increase from 29%-35%. More subs...

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Section: Effect Of Vulnerability On Cancer Outcome In Elderly Patientsmentioning

confidence: 99%

Personalized therapy in multiple myeloma according to patient age and vulnerability: a report of the European Myeloma Network (EMN)

Palumbo

Bringhen

Ludwig

et al. 2011

Blood

312

213

View full text Add to dashboard Cite

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“…17 The presence of comorbid conditions and its treatment could place older patients at a greater risk of dying from breast cancer. Several studies have examined the implication of comorbidities on survival in elderly breast cancer patients over 65 or 75 years of age, 9,10,18,19 but the role of comorbidity as a mediator accounting for relationship between age and survival has not been clearly documented.Although several comorbid measurement systems exist, the Charlson comorbidity score (CCS) has been most popularly studied and considered to be a valid and reliable method of assessing comorbidity for cancer research. 20 Recent reports suggest that the CCS is not entirely adequate because it does not include certain comorbidities such as hypertension that…”

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confidence: 99%

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confidence: 99%

“…10,21 Hypertension is the most prevalent comorbidity among older breast cancer patients and does affect mortality from breast cancer. 9,12,13,15,17,19 This study aimed to evaluate the role of comorbidities including hypertension as a mediator of disparity in survival after metastasis between younger (Յ51 years) and older (Ͼ51 years) patients. The age variable was classified using 51 as a cut-point of old/young group because women in the United States undergo menopause at the mean age of 51, 22,23 and women of Ͼ51 years could be different from women of Յ51 years biologically and clinically in terms of the breast cancer influencing cancer treatment and survival.…”

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confidence: 99%

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Comorbidity as a Mediator of Survival Disparity Between Younger and Older Women Diagnosed With Metastatic Breast Cancer

et al. 2012

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Abstract-The presence of comorbidity becomes increasingly important for its prognostic effect on survival in breast cancer patients with advancing age. This study aimed to evaluate the role of comorbidities including hypertension as a mediator of disparity in survival after metastasis diagnosis between younger (Յ51 years) and older (Ͼ51 years) patients. A total of 553 patients 26 -88 years of age with breast cancer metastasis diagnosis from 1 large urban practice were followed between January 1, 1999, and June 30, 2008. Comorbidity variables and survival were analyzed using Cox regression model. To assess comorbidity variables as a mediator of age-survival relationship, 2 approaches have been applied: (1) Baron Kenny approach and (2) Key Words: advanced breast cancer Ⅲ comorbidity Ⅲ hypertension Ⅲ mediation B reast cancer is the most common cancer among women in the United States and in other industrialized countries and is the second leading cause of death for women with cancer. 1 Distant metastatic breast cancer is the most advanced stage of breast cancer and is found among 7% of women diagnosed with initial breast cancer. 2 Despite the improved adjuvant treatment approaches for early breast cancer, 20 -80% of these patients, depending on the initial stage and the treatment strategy followed, will develop distant metastasis within 5 years of their initial diagnosis. 3 Incidence rates of breast cancer increase with advancing age, predominantly among women over 50 years of age. 4,5 Mortality from breast cancer also increases with age. 4,6 -12 Large numbers of older women with breast cancer have coexistent diseases (comorbidities) at the time of diagnosis, which may influence their treatment options and survival. 9,11,[13][14][15][16] Comorbidity at diagnosis can have an adverse impact on survival. Specifically, Braithwaite et al reported that hypertension was related to survival from breast cancer diagnosis even after adjustment of age, race, and other covariates. 17 The presence of comorbid conditions and its treatment could place older patients at a greater risk of dying from breast cancer. Several studies have examined the implication of comorbidities on survival in elderly breast cancer patients over 65 or 75 years of age, 9,10,18,19 but the role of comorbidity as a mediator accounting for relationship between age and survival has not been clearly documented.Although several comorbid measurement systems exist, the Charlson comorbidity score (CCS) has been most popularly studied and considered to be a valid and reliable method of assessing comorbidity for cancer research. 20 Recent reports suggest that the CCS is not entirely adequate because it does not include certain comorbidities such as hypertension that

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“…Increased age was significantly correlated with worsening performance status as well as worsening function More than 75% of the series had a Charlson score ≥4 (ref. 14 ). An analysis with very similar results has been published by Girre at al.…”

Section: Discussionmentioning

confidence: 99%

Locally advanced breast cancer in elderly patients

Hornová¹,

Bortlíček²,

Májková³

et al. 2017

BIOMED PAP

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Background. Although locally advanced breast cancer (LABC) is more common in the elderly population, there is little data on the clinical characteristics and survival of these patients. The aim of the present study was to compare different factors affecting survival in elderly patients with LABC. Methods. Retrospective analysis was carried out on a cohort of 80 patients aged 70 to 96 years, diagnosed with LABC defined as T3 N1, T4 N0, any N2 or N3, and M0. The prognostic impact of selected clinical parameters including age, comorbidities, tumour grade, HER2 status, tumour stage, local therapies, and systemic treatments was studied. Results. The median age of the patients was 79 years. The majority (n=53; 66%) had at least one significant comorbidity according to the Charlson score evaluation. The median overall survival was 50.6 months. As expected, hormonal therapy was the dominant mode of systemic treatment, but 24% also received at least one line of chemotherapy. Local therapies including surgery and/or radiotherapy were applied in 58% of patients. Conclusions. The diagnosis of LABC in the elderly is associated with poor prognosis. Age and serious comorbidities were negative prognostic factors.

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Comorbidity, disability and geriatric syndromes in elderly breast cancer survivors. Results of a single-center experience

Cited by 63 publications

References 30 publications

Personalized therapy in multiple myeloma according to patient age and vulnerability: a report of the European Myeloma Network (EMN)

Personalized therapy in multiple myeloma according to patient age and vulnerability: a report of the European Myeloma Network (EMN)

Comorbidity as a Mediator of Survival Disparity Between Younger and Older Women Diagnosed With Metastatic Breast Cancer

Locally advanced breast cancer in elderly patients

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