Examining five- and ten-year survival in older women with breast cancer using cancer-specific geriatric assessment

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• 作者：Kerri M. Clough-Gorr^a ; ^b ; ^c ; ^{kmclough@bu.edu} ; Soe Soe Thwin^a ; ^d ; Andreas E. Stuck^e ; Rebecca A. Silliman^a
• 关键词：Assessment ; Breast cancer ; Cancer-specific geriatric assessment ; Decision-making ; Guideline-recommended therapy ; Geriatric assessment ; Older women ; Survival ; Survivor
• 刊名：European Journal of Cancer
• 出版年：2012
• 期刊代码：88_09598049
• 类别：med
• 出版时间：April, 2012
• 卷：48
• 期：6
• 页码：805-812
• 文件大小：461 K

摘要

Purpose

To examine five- and ten-year survival based on cancer-specific geriatric assessment (C-SGA) in older women with early stage breast cancer.

Methods

We evaluated 660 women 猢?5-years old diagnosed with stage I-IIIA primary breast cancer and attending physician permission to contact in four geographic regions in the United States of America (USA). Data were collected over ten-years of follow-up from consenting women鈥檚 medical records, telephone interviews, National Death Index and Social Security Death Index. C-SGA was described by four domains using six measures: socio-demographic (financial resources); clinical (comorbidity, obesity); function (physical function limitations); and psychosocial (general mental health, social support). Survival from all-cause and breast-cancer-specific mortality and receipt of guideline-recommended therapy was assessed for different groups of subjects with C-SGA domain deficits (cut-off 猢? deficits).

Results

The proportion of women with 猢? C-SGA deficits surviving ten-years was consistently statistically significantly lower (all-cause 26%versus 46%and breast-cancer-specific 76%versus 89%, p 猢?#xA0;0.04). The proportion significantly decreased as number of C-SGA deficits increased (linear trend p < 0.0001). Receipt of guideline-recommended therapy decreased with age but not consistently by number of C-SGA deficits. The all-cause and breast-cancer-specific death rate at five- and ten-years was consistently approximately two times higher in women with 猢? C-SGA deficits even when fully adjusted for confounding factors (HR_{5-yrAllCauseFullyAdjusted} = 1.87 [1.36-2.57], HR_{10-yrAllCauseFullyAdjusted} = 1.74 [1.35-2.15], HR_{5-yrBreastCancerFullyAdjusted} = 1.95 [1.18-3.20], HR_{10-yrBreastCancerFullyAdjusted} = 1.99 [1.21-3.28]).

Conclusion

Regardless of age and stage of disease, C-SGA predicts five- and ten-year all-cause and breast-cancer-specific survival in older women. Hence, C-SGA may provide an effective strategy to guide treatment decision-making and to identify risk factors for intervention.