Nicolò Matteo Luca Battisti1, Matthew Q Hatton2, Malcolm W R Reed3, Esther Herbert4, Jenna L Morgan5, Michael Bradburn4, Richard Simcock6, Stephen J Walters4, Karen A Collins7, Sue E Ward8, Geoffrey R Holmes8, Maria Burton7, Kate J Lifford9, Adrian Edwards9, Thompson G Robinson10, Charlene Martin5, Tim Chater4, Kirsty J Pemberton4, Alan Brennan8, Kwok Leung Cheung11, Annaliza Todd5, Riccardo A Audisio12, Juliet Wright3, Tracy Green13, Deirdre Revell13, Jacqui Gath13, Kieran Horgan14, Chris Holcombe15, Matthew C Winter2, Jay Naik16, Rishi Parmeshwar17, Margot A Gosney18, Alastair M Thompson19, Lynda Wyld20, Alistair Ring1. 1. Department of Medicine, Breast Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK & Breast Cancer Research Division, The Institute of Cancer Research, London, UK. 2. Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, UK. 3. Brighton and Sussex Medical School, Brighton, UK. 4. Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, UK. 5. Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK. 6. Brighton and Sussex University Hospitals NHS Trust, Brighton, UK. 7. College of Health, Wellbeing and Life Sciences, Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK. 8. Department of Health Economics and Decision Science, School for Health and Related Research (ScHARR), University of Sheffield, UK. 9. Division of Population Medicine, Cardiff University, Cardiff, UK. 10. Department of Cardiovascular Sciences and NIHR Biomedical Research Centre, University of Leicester, Cardiovascular Research Centre, Leicester, UK. 11. School of Medicine, University of Nottingham, Royal Derby Hospital, Derby, UK. 12. University of Gothenberg, Sahlgrenska Universitetssjukhuset, Göteborg, Sweden. 13. Yorkshire and Humber Consumer Research Panel, Sheffield, UK. 14. Department of Breast Surgery, Bexley Cancer Centre, St James's University Hospital, Leeds, UK. 15. Liverpool University Hospitals Foundation Trust, Liverpool, UK. 16. Pinderfields Hospital, Mid Yorkshire NHS Foundation Trust, Wakefield, UK. 17. University Hospitals of Morecambe Bay, Royal Lancashire Infirmary, Lancaster, UK. 18. Royal Berkshire NHS Foundation Trust, Reading, UK. 19. Department of Surgery, Baylor College of Medicine, Houston, USA. 20. Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK. Electronic address: l.wyld@sheffield.ac.uk.
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.
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.
Authors: Neil Carleton; Azadeh Nasrazadani; Kristine Gade; Sushil Beriwal; Parul N Barry; Adam M Brufsky; Rohit Bhargava; Wendie A Berg; Margarita L Zuley; G J van Londen; Oscar C Marroquin; Darcy L Thull; Phuong L Mai; Emilia J Diego; Michael T Lotze; Steffi Oesterreich; Priscilla F McAuliffe; Adrian V Lee Journal: Lancet Healthy Longev Date: 2022-01-05