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Breast Cancer Res Treat. 2018 Apr;168(2):433-441. doi: 10.1007/s10549-017-4607-8. Epub 2017 Dec 14.

Impact of geriatric assessment for the therapeutic decision-making of breast cancer: results of a French survey. AFSOS and SOFOG collaborative work.

Author information

1
Geriatrics Unit, Lyon Sud University Hospital, Hospices Civils de Lyon and Lyon University, 165 chemin du Grand Revoyet, 69495, Pierre-Bénite Cedex, France. claire.falandry@chu-lyon.fr.
2
Department of Medical Oncology, Institut Bergonié, Bordeaux, France.
3
Department of Medical Oncology, CHU de Grenoble, La Tronche, France.
4
Department of Medical Oncology, Groupe Hospitalier Public du Sud de l'Oise, Senlis, France.
5
Department of Geriatrics, Hôpital Cimiez, Nice, France.
6
Chugai Pharma France, Paris, France.
7
Department of Medical Oncology, Lyon Sud University Hospital, Hospices Civils de Lyon and Lyon University, Pierre-Bénite, France.

Abstract

BACKGROUND:

Cancer management in the elderly is often considered as suboptimal, highly variable, and rarely evidence-based. Data are needed to understand decision-making processes in this population.

MATERIALS AND METHODS:

A survey was performed in France to describe decision-making in gynaecologic patients over 70. It followed a three-step method: (1) 101 representative physicians questioned about treatment decision criteria; (2) simplified individual data were collected; (3) as well as detailed data patients receiving chemotherapy. This analysis refers to breast cancer subgroup of patients.

RESULTS:

Main decision criteria were performance status, comorbidities, and renal function. In adjuvant setting, the main concern was life expectancy, whereas it was quality of life in metastatic setting. Of the 631 patients entered in the simplified analysis, 41% had been evaluated by a geriatrician, 67% received chemotherapy. In the detailed analysis, patients older than 75 were more likely to receive a monochemotherapy and to be treated with weekly/divided dose. In adjuvant setting, respectively, 19, 55, and 26% of the patients were treated with regimen validated in the elderly, validated in a younger population, and not validated. A G-CSF was prescribed in 48% of the patients, as primary prophylaxis in 78 and in 41% of patients with a risk of febrile neutropenia < 10%.

CONCLUSION:

Geriatric covariates become an increasing concern in the decision-making process. This survey also suggests an insufficient use of validated chemotherapy regimens. To date, age remains a risk factor for heterogeneity in oncologic practice justifying a persistent effort for elaborating and disclosing specific recommendations.

KEYWORDS:

Breast cancer; Decision-making; Elderly patients; Geriatric assessment; Guidelines

PMID:
29243107
DOI:
10.1007/s10549-017-4607-8
[Indexed for MEDLINE]

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