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Care of breast cancer in the elderly woman—what does comprehensive geriatric assessment (CGA) help?

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Abstract

Breast cancer is the most common cancer in women in Europe and Northern America. Its incidence and mortality rates are increasing with advance in age. Only few elderly women with breast cancer are treated in clinical trials. Elderly women with the same numerical age are very heterogeneous considering their biological age. Geriatric medicine has established comprehensive geriatric assessment (CGA) to get important information on elderly patients missed by a routine clinical history and physical examination. The data collected in CGA are of prognostic relevance for mortality, morbidity, maintenance of independence and utilisation of health care resources. Within the last few years, some research groups have demonstrated that the use of CGA in elderly cancer patients collects information missed by the currently established workup of these patients and that this information is of prognostic relevance concerning toxicity of chemotherapy and mortality. The use of CGA in a population of general elderly patients improves functional status and mental health, but so far no effect on mortality could be demonstrated. A subgroup analysis of the elderly cancer patients within this trial additionally demonstrated an improvement in pain control. Special data concerning the use of CGA within the group of elderly breast cancer patients are not published so far. The authors suggest areas of care for elderly women with breast cancer within which the CGA might be able to improve treatment and which should be a field of randomised controlled trials in the future.

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References

  1. Anonymous (1998) Polychemotherapy for early breast cancer: an overview of the randomised trials. Early Breast Cancer Trialists’ Collaborative Group [see comments]. Lancet 352(9132):930–942

    PubMed  Google Scholar 

  2. Balducci L (1999) Special problems of cancer management in older individuals. In: Perry, MC (ed), 1999 Educational Book, American Society of Clinical Oncology, pp 346–352

  3. Bates T, Riley DL, Houghton J, Fallowfield L, Baum M (1991) Breast cancer in elderly women: a Cancer Research Campaign trial comparing treatment with tamoxifen and optimal surgery with tamoxifen alone. The Elderly Breast Cancer Working Party. Br J Surg 78(5):591–594

    CAS  PubMed  Google Scholar 

  4. Cohen HJ, Feussner JR, Weinberger M, Carnes M, Hamdy RC, Hsieh F, Phibbs C, Courtney D, Lyles KW, May C, McMurtry C, Pennypacker L, Smith DM, Ainslie N, Hornick T, Brodkin K, Lavori P (2002) A controlled trial of inpatient and outpatient geriatric evaluation and management. N Engl J Med 346(12):905–912

    Article  PubMed  Google Scholar 

  5. Cohen HJ (2002) Geriatric Evaluation and Management Units in the Care of the Elderly Cancer Patient: 7th International Conference on Cancer in the Elderly, Boston, 2002

    Google Scholar 

  6. Corcoran ME (1997) Polypharmacy in the older patient with cancer. Cancer Control 4(5):419–428

    Google Scholar 

  7. Daidone MG, Coradini D, Martelli G, Veneroni S (2003) Primary breast cancer in elderly women: biological profile and relation with clinical outcome. Crit Rev Oncol Hematol 45(3):313–325

    Article  PubMed  Google Scholar 

  8. Extermann M, Overcash J, Lyman GH, Parr J, Balducci L (1998) Comorbidity and functional status are independent in older cancer patients. J Clin Oncol 16(4):1582–1587

    CAS  PubMed  Google Scholar 

  9. Fentiman IS, Christiaens MR, Paridaens R, Van Geel A, Rutgers E, Berner J, de Keizer G, Wildiers J, Nagadowska M, Legrand C, Therasse P (2003) Treatment of operable breast cancer in the elderly: a randomised clinical trial EORTC 10851 comparing tamoxifen alone with modified radical mastectomy. Eur J Cancer 39(3):309–16

    Article  CAS  PubMed  Google Scholar 

  10. Fentiman IS, van Zijl J, Karydas I, Chaudary MA, Margreiter R, Legrand C, Therasse P (2003) Treatment of operable breast cancer in the elderly: a randomised clinical trial EORTC 10850 comparing modified radical mastectomy with tumorectomy plus tamoxifen. Eur J Cancer 39(3):300–308

    Article  CAS  PubMed  Google Scholar 

  11. Frasci G, Lorusso V, Panza N, Comella P, Nicolella G, Bianco A, De Cataldis G, Iannelli A, Bilancia D, Belli M, Massidda B, Piantedosi F, Comella G, De Lena M (2000) Gemcitabine plus vinorelbine versus vinorelbine alone in elderly patients with advanced non-small-cell lung cancer. J Clin Oncol 18(13):2529–2536

    CAS  PubMed  Google Scholar 

  12. Friedrich C, Kolb G, Wedding U, Pientka L (2003) Comprehensive geriatric assessment in the elderly cancer patient. Onkologie 26(4):355–360

    Article  CAS  PubMed  Google Scholar 

  13. Hurria A, Leung D, Trainor K, Borgen P, Norton L, Hudis C (2003) Factors influencing treatment patterns of breast cancer patients age 75 and older. Crit Rev Oncol Hematol 46(2):121–126

    Article  Google Scholar 

  14. Hutchins LF, Unger JM, Crowley JJ, Coltman CA Jr, Albain KS (1999) Underrepresentation of patients 65 years of age or older in cancer-treatment trials. N Engl J Med 341(27):2061–2067

    Article  CAS  PubMed  Google Scholar 

  15. Mayer F, Lipp HP, Kanz L, Bokemeyer C (2000) Supportive Therapie und der Einsatz zytostatischer Substanzen bei geriatrisch-onkologischen Patienten. Euro J Ger 2(4):188–197

    Google Scholar 

  16. Rembold CM (1998) Number needed to screen: development of a statistic for disease screening. BMJ 317(7154):307–312

    CAS  PubMed  Google Scholar 

  17. Repetto L, Fratino L, Audisio RA, Venturino A, Gianni W, Vercelli M, Parodi S, Dal Lago D, Gioia F, Monfardini S, Aapro MS, Serraino D, Zagonel V (2002) Comprehensive geriatric assessment adds information to Eastern Cooperative Oncology Group performance status in elderly cancer patients: an Italian Group for Geriatric Oncology Study. J Clin Oncol 20(2):494–502

    Article  PubMed  Google Scholar 

  18. Ries L, et al (2001) SEER Cancer Statistics Review, 1973–1999. National Cancer Institute, Bethesda, MD, 2001 http://seer.cancer.gov/csr/1973_1999/ (cited 19 Sept 2003)

  19. 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

    CAS  PubMed  Google Scholar 

  20. Turner NJ, Haward RA, Mulley GP, Selby PJ (1999) Cancer in old age—is it inadequately investigated and treated? BMJ 319(7205):309–312

    CAS  PubMed  Google Scholar 

  21. Veronesi U, Luini A, Del Vecchio M, Greco M, Galimberti V, Merson M, Rilke F, Sacchini V, Saccozzi R, Savio T, et al (1993) Radiotherapy after breast-preserving surgery in women with localized cancer of the breast. N Engl J Med 328(22):1587–1591

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Hämatologie–Onkologie–Gastroenterologie–Hepatologie–Infektiologie, Klinik und Poliklinik für Innere Medizin II, Klinikum der Friedrich Schiller Universität, Erlanger Allee 101, 07747 , Jena, Germany

    Ulrich Wedding & Klaus Höffken

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  1. Ulrich Wedding
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  2. Klaus Höffken
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Correspondence to Ulrich Wedding.

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Presented as an invited lecture at the 15th International Symposium Supportive Care in Cancer, Berlin, Germany, June 18–21, 2003

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Wedding, U., Höffken, K. Care of breast cancer in the elderly woman—what does comprehensive geriatric assessment (CGA) help?. Support Care Cancer 11, 769–774 (2003). https://doi.org/10.1007/s00520-003-0537-6

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  • DOI: https://doi.org/10.1007/s00520-003-0537-6

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