The number of elderly breast cancer patients is strongly increasing due to aging. The use of a geriatric assessment in this population has been advocated in many studies and guidelines to identify high risk populations for early mortality and toxicity. Additionally, they could predict relevant outcomes such as quality of life and functional status. This systematic review summarizes all available evidence on predictive factors for disease-specific and patient-reported outcome measures in older patients with breast cancer.
We performed a systematic review of Pubmed and Embase using keywords “breast cancer”, “prediction” and “elderly” and screened all titles that were published up to June 2017 by two independent reviewers. Papers that investigated the relation between predictive markers (disease-related or patient-related) and disease-specific outcomes, toxicity or patient-reported outcomes (such as quality of life, functional status) were included.
104 papers were included out of 1324 screened titles. Most studies investigated breast cancer-specific outcomes such as survival or recurrence (N = 95). The main predictors were disease-related measurements such as tumor stage or grade. However functional status, cognitive status, comorbidity and gait speed were highly predictive of overall mortality. Treatment toxicity was predicted by age, comorbidity, functional status and polypharmacy. Patient-reported outcomes such as functional status, cognitive decline and emotional functioning were studied in a minority of studies (N = 12) and were predicted by comorbidity, polypharmacy, nutritional and functional status.
This study shows that geriatric parameters can predict survival and patient-reported outcomes in elderly breast cancer patients. This can be used in daily clinical practice to identify patients at risk of early mortality, treatment toxicity or poor functional outcome after treatment. A minority of studies used relevant outcome measures for older patients, showing the need for studies that are tailored for the older population.
The authors.
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All authors have declared no conflicts of interest.