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

Abstract

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 ≥65-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's 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 ≥3 deficits).

Results: The proportion of women with ≥3 C-SGA deficits surviving ten-years was consistently statistically significantly lower (all-cause 26% versus 46% and breast-cancer-specific 76% versus 89%, p≤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 ≥3 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.

Figure 1

Proportion of women with zero to four cancer-specific geriatric assessment (C-SGA) domain deficits at baseline by age group in a longitudinal study of older women with breast cancer (N=660), 1997-2007

Figure 2

Proportion of the total population (N=660) surviving all-cause at five- and ten-years follow-up by number of cancer-specific geriatric assessment (C-SGA) deficits and age (65-69-years, 70-79-years, 80+-years) in a longitudinal study of older women with breast cancer, 1997-2007 a) Proportion by Number of C-SGA Deficits b) Proportion by C-SGA Cut-off in Ages 65-69 Years c) Proportion by C-SGA Cut-off in Ages 70-79 Years d) Proportion by C-SGA Cut-off in Ages 80+ Years

Figure 3

Survival plot of five- and ten-year all-cause and breast-cancer-specific survival based on cancer-specific geriatric assessment (C-SGA) in a longitudinal study of older women with breast cancer (N=660), 1997-2007

Figure 4

Proportion of total population (N=660) with and without guideline-recommended therapy by age group, C-SGA cut-off, and number of C-SGA deficits in a longitudinal study of older women with breast cancer, 1997-2007