Observational cohort study in older women with early breast cancer: Use of radiation therapy and impact on health-related quality of life and mortality. (August 2021)

• Record Type: Journal Article
• Authors: Battisti, Nicolò Matteo Luca; Hatton, Matthew Q.; Reed, Malcolm W.R.; Herbert, Esther; Morgan, Jenna L.; Bradburn, Michael; Simcock, Richard; Walters, Stephen J.; Collins, Karen A.; Ward, Sue E.; Holmes, Geoffrey R.; Burton, Maria; Lifford, Kate J.; Edwards, Adrian; Robinson, Thompson G.; Martin, Charlene; Chater, Tim; Pemberton, Kirsty J.; Brennan, Alan; Leung Cheung, Kwok; Todd, Annaliza; Audisio, Riccardo A.; Wright, Juliet; Green, Tracy; Revell, Deirdre; Gath, Jacqui; Horgan, Kieran; Holcombe, Chris; Winter, Matthew C.; Naik, Jay; Parmeshwar, Rishi; Gosney, Margot A.; Thompson, Alastair M.; Wyld, Lynda; Ring, Alistair;
• Is Part Of: Radiotherapy and oncology. Volume 161(2021)
• Page Start: 166
• Page End: 176
• Publication Date: 2021-08
• Subjects: Breast cancer -- Older -- Frailty -- Comorbidity -- Health-related quality of life -- Adjuvant radiotherapy; Oncology -- Periodicals; Radiotherapy -- Periodicals; Tumors -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiothérapie -- Périodiques; Cancérologie -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9940642
• DOI: 10.1016/j.radonc.2021.06.021
• Languages: English
• ISSNs: 0167-8140

Abstract

Highlights: Radiotherapy use in older early-stage breast cancer patients is affected by age and relapse risk. Despite geographical variation, geriatric parameters do not influence radiotherapy decisions. Some fit older women with high-risk tumours do not receive radiotherapy. Some older patients with low-risk cancer receive radiotherapy after breast-conserving surgery. The impact of radiotherapy on quality-of-life is transient and mostly resolves by 18 months. Abstract: Background: Radiotherapy reduces in-breast recurrence risk in early breast cancer (EBC) in older women. This benefit may be small and should be balanced against treatment effect and holistic patient assessment. This study described treatment patterns according to fitness and impact on health-related quality-of-life (HRQoL). Methods: A multicentre, observational study of EBC patients aged ≥ 70 years, undergoing breast-conserving surgery (BCS) or mastectomy, was undertaken. Associations between radiotherapy use, surgery, clinico-pathological parameters, fitness based on geriatric parameters and treatment centre were determined. HRQoL was measured using the European Organisation for the Research and Treatment of Cancer (EORTC) questionnaires. Results: In 2013–2018 2811 women in 56 UK study centres underwent surgery with a median follow-up of 52 months. On multivariable analysis, age and tumour risk predicted radiotherapy use. Among healthier patients (based on geriatric assessments) with high-risk tumours, 534/613 (87.1%) having BCS and 185/341 (54.2%) having mastectomy received radiotherapy. In less fit individuals with low-risk tumours undergoing BCS, 149/207 (72.0%) received radiotherapy. Radiotherapy effects on HRQoL domains, including breast symptoms and fatigue were seen, resolving by 18 months. Conclusion: Radiotherapy use in EBC patients ≥ 70 years is affected by age and recurrence risk, whereas geriatric parameters have limited impact regardless of type of surgery. There was geographical variation in treatment, with some fit older women with high-risk tumours not receiving radiotherapy, and some older, low-risk, EBC patients receiving radiotherapy after BCS despite evidence of limited benefit. The impact on HRQoL is transient.