Skip to main content

Advertisement

SpringerLink
Log in

The role of comorbidity assessment in guiding treatment decision-making for women with early breast cancer: a systematic literature review

  • Review Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

Comorbidity in breast cancer patients impacts treatment choice, toxicity, and outcomes. While comorbidity measurement tools are frequently used by researchers, little is known about their use in clinical practice. The aim of this review was to examine the use of comorbidity measurement tools in clinical practice and their role in treatment decision-making in breast cancer.

Methods

Six electronic databases were searched from inception to 21 March 2019. Quantitative or mixed methods studies addressing primary treatment of breast cancer and identifying a comorbidity measurement tool used in clinical practice treatment decision-making were included. Data was extracted on tool utilized, impact on treatment decisions or outcomes, pattern of use, and psychometric properties.

Results

A systematic search of literature yielded 752 studies. Of the four studies that met inclusion criteria, each utilized a comprehensive geriatric assessment tool, though only in a subset of patients. No studies found direct comorbidity measurement tools utilized independently of geriatric assessment. Assessment results had variable impact on treatment decisions. Impacts on patient mortality and treatment toxicity, cost-effectiveness, and psychometric characteristics of the tools were not identified.

Conclusions

There is little evidence on use of specific comorbidity tools in clinical decision-making in breast cancer outside of comorbidity assessment as part of geriatric assessment tools. There was limited impact on decision-making or patient outcomes when these were utilized. Further research is needed to identify barriers to comorbidity assessment in clinical practice and identify comorbidity tools that have the potential to improve patient outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. World Health Organisation 2017. Breast cancer: prevention and control. https://www.who.int/cancer/detection/breastcancer/en/index1.html.

  2. Hong CC., Ambrosone C.B., Goodwin P.J. (2015) Comorbidities and their management: potential impact on breast cancer outcomes. In: Ganz P. (eds) improving outcomes for breast cancer survivors. Advances in experimental medicine and biology, vol 862. Springer, Cham

    Chapter  Google Scholar 

  3. Ng HS, Roder D, Koczwara B, Vitry A (2018) Development of comorbidities in women with hormone-dependent breast cancer: an Australian population-based analysis. Med J Aust 208(1):24–28

    Article  PubMed  Google Scholar 

  4. Edwards B, Noone A, Mariotto A, Simard E, Boscoe F, Henley S, Jemal A, Cho H, Anderson R, Kohler B, Eheman C, Ward E (2014) Annual report to the nation on the status of cancer, 1975-2010, featuring prevalence of comorbidity and impact on survival among persons with lung, colorectal, breast, or prostate cancer. Cancer. 120:1290–1314

    Article  PubMed  Google Scholar 

  5. Sarfati D, Koczwara B, Jackson C (2016) The impact of comorbidity on cancer and its treatment. CA Cancer J Clin 66(4):338–350

    Article  Google Scholar 

  6. Sarfati D, Tan L, Blakely T, Pearce N (2011) Comorbidity among patients with colon cancer in New Zealand. N Z Med J 124:76–88

    PubMed  Google Scholar 

  7. Lee L, Cheung W, Atkinson E, Krzyzanowska M (2011) Impact of comorbidity on chemotherapy use and outcomes in solid tumors: a systematic review. J Clin Oncol 29:106–117

    Article  PubMed  Google Scholar 

  8. Hall W, Jani A, Ryu J, Narayan S, Vijayakumar S (2005) The impact of age and comorbidity on survival outcomes and treatment patterns in prostate cancer. Prostate Cancer Prostatic Dis 8:2230

    Article  Google Scholar 

  9. Rieker R, Hammer E, Eisele R, Schmid E, Hogel J (2002) The impact of comorbidity on the overall survival and the cause of death in patients after colorectal cancer resection. Langenbeck's Arch Surg 387:72–76

    Article  Google Scholar 

  10. Dehal A, Abbas A, Johna S (2013) Comorbidity and outcomes after surgery among women with breast cancer: analysis of nationwide in-patient sample database. Breast Cancer Res Treat 139:469–476

    Article  PubMed  Google Scholar 

  11. van Gestel Y, Lemmens V, de Hingh I, Steevens J, Rutten H, Nieuwenhuijzen G, van Dam R, Siersema P (2013) Influence of comorbidity and age on 1-, 2-, and 3-month postoperative mortality rates in gastrointestinal cancer patients. Ann Surg Oncol 20:371–380

    Article  PubMed  Google Scholar 

  12. Tomaszewski J, Uzzo R, Kutikov A, Hrebinko K, Mehrazin R, Corcoran A, Ginzburg S, Viterbo R, Chen D, Greenberg R, Smaldone MC (2014) Assessing the burden of complications after surgery for clinically localized kidney cancer by age and comorbidity status. Urology. 83:843–849

    Article  PubMed  Google Scholar 

  13. Miranda V, Fede A, Nobuo M, Ayres V, Giglio A, Miranda M, Riechelmann RP (2011) Adverse drug reactions and drug interactions as causes of hospital admission in oncology. J Pain Symptom Manag 42(3):342–353

    Article  Google Scholar 

  14. Sasaki T, Fujita K, Sunakawa Y, Ishida H, Yamashita K, Miwa K, Saji S, Kato Y, Sasaki Y (2013) Concomitant polypharmacy is associated with irinotecan-related adverse drug reactions in patients with cancer. Int J Clin Oncol 18:735–742

    Article  CAS  PubMed  Google Scholar 

  15. Satariano W (1992) Comorbidity and functional status in older women with breast cancer: implications for screening, treatment, and prognosis. The Journal of Gerontology 47:24–31

    PubMed  Google Scholar 

  16. Meneses K, Benz R, Azuero A, Jablonski-Jaudon R, McNees P (2015) Multimorbidity and breast cancer. Semin Oncol Nurs 31(2):163–169

    Article  PubMed  Google Scholar 

  17. Edwards M, Campbell I, Lawrenson R, Kuper-Hommel M (2017) Influence of comorbidity on chemotherapy use for early breast cancer: systematic review and meta-analysis. Breast Cancer Res Treat 165(1):17–39

    Article  PubMed  Google Scholar 

  18. Satariano W. (1993) Ageing, comorbidity and breast cancer survival: an epidemiologic view: Yang S.S., Warner H.R. (eds) The underlying molecular, cellular and immunological factors in cancer and aging. Advances in experimental medicine and biology.330:1–11

  19. Land L, Dalton S, Jorgensen T, Ewertz M (2012) Comorbidity and survival after early breast cancer. A review critical reviews in oncology/haematology 81:196–205

    Article  Google Scholar 

  20. Graves T, Bland K (1995) Comorbidity risk parameters associated with advanced breast cancer and systemic disease. Management of non breast disease. Surg Oncol Clin N Am 4(4):633–656

    Article  CAS  PubMed  Google Scholar 

  21. Sarfati D (2016) How do we measure comorbidity? In: Koczwara B (ed) Cancer and chronic conditions: addressing the problem of multimorbidity in cancer patients and survivors. Springer, Singapore, pp 35–70

    Chapter  Google Scholar 

  22. Extermann M, Hurria A (2007) Comprehensive geriatric assessment for older patients with cancer. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology 25(14):1824–1831

    Article  Google Scholar 

  23. Hamaker M, Te Molder M, Thielen N, van Munster B, Schiphorst A, van Huis L (2018) The effect of a geriatric evaluation on treatment decisions and outcome for older cancer patients - a systematic review. Journal of Geriatric Oncology 9(5):430–440

    Article  PubMed  Google Scholar 

  24. Vitry A, Wong S, Roughead E, Ramsay E, Barratt J (2009) Validity of medication-based co-morbidity indices in the Australian elderly population. Aust N Z J Public Health 33(2):126–130

    Article  PubMed  Google Scholar 

  25. Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(6):e1000097. https://doi.org/10.1371/journal.pmed1000097

    Article  PubMed  PubMed Central  Google Scholar 

  26. Kmet L M, Lee R C, Cook L S. (2004) Standard quality assessment criteria for evaluating primary research papers from a variety of fields. Edmonton: Alberta Heritage Foundation for Medical Research (AHFMR). AHFMR - HTA initiative #13

  27. Barthélémy P, Heitz D, Mathelin C, Polesi H, Asmane I, Litique V, Rob L, Bergerat J.-P, Kurtz J.-E (2011) . Adjuvant chemotherapy in elderly patients with early breast cancer. Impact of age and comprehensive geriatric assessment on tumor board proposals. Crit Rev Oncol Hematol 79(2): 196–204

    Article  PubMed  Google Scholar 

  28. Extermann M, Meyer J, Mcginnis M, Crocker T, Corcoran M-B, Yoder J, Haley W, Chen H, Boulware D, Balducci L (2004) A comprehensive geriatric intervention detects multiple problems in older breast cancer patients. Critical Reviews in Oncology and Hematology 49(1):69–75

    Article  Google Scholar 

  29. Stotter A, Reed M, Gray L, Moore N, Robinson T (2015) Comprehensive geriatric assessment and predicted 3-year survival in treatment planning for frail patients with early breast cancer. Br J Surg 102(5):525–533

    Article  CAS  PubMed  Google Scholar 

  30. Falandry C, Krakowski I, Cure H, Carola E, Soubeyran P, Guerin O, Gaudin H, Freyer G (2018) Impact of geriatric assessment for the therapeutic decision-making of breast cancer: results of a French survey. AFSOS and SOFOG collaborative work. Breast Cancer Res Treat 168(2):433–441

    Article  PubMed  Google Scholar 

  31. Decoster L, Van Puyvelde K, Mohile S, Wedding U, Basso U, Colloca G, Rostoft S, Overcash J, Wildiers H, Steer C, Kimmick G, Kanesvaran R, Luciani A, Terret C, Hurria A, Kenis C, Audisio R, Extermann M (2015) Screening tools for multidimensional health problems warranting a geriatric assessment in older cancer patients: an update on SIOG recommendations. Ann Oncol 26(2):288–300

    Article  CAS  PubMed  Google Scholar 

  32. Kenis B, Libert D, Puyvelde V, Scalliet C, Pepersack L, Langenaeken R, Allepaerts VR, Milisen F, Lobelle, Wildiers (2013) Relevance of a systematic geriatric screening and assessment in older patients with cancer: results of a prospective multicentric study. Ann Oncol 24(5):1306–1312

    Article  CAS  PubMed  Google Scholar 

  33. Mohile S, Dale W, Somerfield M, Schonberg M, Boyd C, Burhenn P, Canin B, Cohen H, Holmes H, Hopkins J, Janelsins M, Khorana A, Klepin H, Lichtman S, Mustian K, Tew W, Hurria A (2018) Practical assessment and management of vulnerabilities in older patients receiving chemotherapy: ASCO guideline for geriatric oncology. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology 36(22):2326–2347

    Article  Google Scholar 

  34. (2015) ESMO Handbook of Cancer in the Senior Patient. <https://oncologypro.esmo.org/content/download/21558/354915/file/2015-ESMO-Handbook-Cancer-Senior-Patient.pdf>

  35. (2019) National comprehensive cancer network NCCN guidelines for older adult oncology version 1. https://www.nccn.org/professionals/physician_gls/pdf/senior.pdf

  36. Extermann M, Aapro M, Bernabei R, Cohen H, Droz J-P, Lichtman S, Mor V, Monfardini S, Repetto L, Sørbye L, Topinkova E (2005) Use of comprehensive geriatric assessment in older cancer patients. Critical Reviews in Oncology and Hematology 55(3):241–252

    Article  Google Scholar 

  37. Caillet P, Pamoukdjian F, Obraztsova A, Paillaud E (2018) Comprehensive geriatric assessment in cancer patients. In: Pilotto A, Martin F (eds) Comprehensive geriatric assessment. Practical Issues in Geriatrics. Springer

  38. Wildiers H, Heeren P, Puts M, Topinkova E, Janssen-Heijnen M, Extermann M, Falandry C, Artz A, Brain E, Colloca G, Flamaing J, Karnakis T, Kenis C, Audisio R, Mohile S, Repetto L, Van Leeuwen B, Milisen K, Hurria A (2014) International society of geriatric oncology consensus on geriatric assessment in older patients with cancer. J Clin Oncol 32(24):2595–2603

    Article  PubMed  PubMed Central  Google Scholar 

  39. Australian Institute of Health and Welfare (AIHW) 2018 Cancer Data in Australia; Canberra: AIHW. <https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia/>.

  40. Lawn S, Fallon-Ferguson J, Koczwara B (2017) Shared care involving cancer specialists and primary care providers – what do cancer survivors want? Health Expect 20(5):1081–1087

    Article  PubMed  PubMed Central  Google Scholar 

  41. Linn B, Linn M, Gurel L (1968) Cumulative illness rating scale. J Am Geriatr Soc 16(622):626

    Google Scholar 

  42. Miller M, Towers A (1991) A manual of guidelines for scoring the cumulative illness rating scale for geriatrics (CIRS-G). University of Pittsburg, Pittsburg, PA

    Google Scholar 

  43. Charlson M, Pompei P, Ales K, MacKenzie C (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383

    Article  CAS  PubMed  Google Scholar 

  44. Satariano WA, Ragland DR (1994) The effect of comorbidity on 3-year survival of women with primary breast cancer. Ann Intern Med 120(2):104–110

    Article  CAS  PubMed  Google Scholar 

  45. Conwell Y, Forbes N, Cox C, Caine E (1993) Validation of a measure of physical illness burden at autopsy: the cumulative illness rating scale. J Am Geriatr Soc 41:38–41

    Article  CAS  PubMed  Google Scholar 

  46. Lash T, Horton N, Guadagnoli E, Silliman R (2003) Multiple informants: a new method to assess breast cancer patients' comorbidity. Am J Epidemiol 157(3):249–257

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to thank Dr. Lisa Beatty and Dr. Emma Kemp for their assistance in the systematic review process.

Author information

Authors and Affiliations

  1. Flinders University, Adelaide, SA, Australia

    Stephanie Webster

  2. Department of Psychiatry, Flinders University, Adelaide, SA, Australia

    Sharon Lawn

  3. School of Nursing, Queensland University of Technology, Kelvin Grove, QLD, Australia

    Raymond Chan

  4. Flinders Centre for Innovation in Cancer, Flinders University and Flinders Medical Centre, Adelaide, SA, Australia

    Bogda Koczwara

Authors
  1. Stephanie Webster
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sharon Lawn
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Raymond Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bogda Koczwara
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bogda Koczwara.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Webster, S., Lawn, S., Chan, R. et al. The role of comorbidity assessment in guiding treatment decision-making for women with early breast cancer: a systematic literature review. Support Care Cancer 28, 1041–1050 (2020). https://doi.org/10.1007/s00520-019-05218-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-019-05218-w

Keywords

Search

Navigation