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Observational Study
. 2021 Aug:161:166-176.
doi: 10.1016/j.radonc.2021.06.021. Epub 2021 Jun 17.

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

Nicolò Matteo Luca Battisti  1 , Matthew Q Hatton  2 , Malcolm W R Reed  3 , Esther Herbert  4 , Jenna L Morgan  5 , Michael Bradburn  4 , Richard Simcock  6 , Stephen J Walters  4 , Karen A Collins  7 , Sue E Ward  8 , Geoffrey R Holmes  8 , Maria Burton  7 , Kate J Lifford  9 , Adrian Edwards  9 , Thompson G Robinson  10 , Charlene Martin  5 , Tim Chater  4 , Kirsty J Pemberton  4 , Alan Brennan  8 , Kwok Leung Cheung  11 , Annaliza Todd  5 , Riccardo A Audisio  12 , Juliet Wright  3 , Tracy Green  13 , Deirdre Revell  13 , Jacqui Gath  13 , Kieran Horgan  14 , Chris Holcombe  15 , Matthew C Winter  2 , Jay Naik  16 , Rishi Parmeshwar  17 , Margot A Gosney  18 , Alastair M Thompson  19 , Lynda Wyld  20 , Alistair Ring  1 ; Bridging the Age Gap TMG
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Free article
Observational Study

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

Nicolò Matteo Luca Battisti et al. Radiother Oncol. 2021 Aug.
Free article

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.

Keywords: Adjuvant radiotherapy; Breast cancer; Comorbidity; Frailty; Health-related quality of life; Older.

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