Author(s): Girons R, Torregrosa D, DazBeveridge R
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Abstract Advancing age is a major risk factor for breast cancer. Long-term follow-up is recommended after diagnosis and treatment of early breast cancer. With older age, the risk of comorbid conditions and functional impairment increases. A useful tool in the management and follow-up of these elderly patients could be a comprehensive geriatric assessment (CGA). PURPOSE: A descriptive, transversal study was carried out of the prevalence of other comorbidities and of the functional impairment in elderly patients on follow-up after curative treatment of early breast cancer. PATIENTS: Women aged> or =70 at diagnosis; early breast cancer treated surgically. No disease recurrence allowed. METHODS: CGA was conducted in an oncology unit using screening instruments (activities of daily living [ADL]; instrumental activities of daily living [IADL]; body mass index [BMI]; geriatric depression scale [GDS]). Cognitive status was reported by the patient. Comorbidity was classified using the Charlson score. RESULTS: From January 2005 to June 2006 91 patients were seen. Mean age at surgery: 76 (70-92). Mean age at CGA: 80 (71-95). Aged population (almost 25\% were more than 84 at the time of CGA). Median follow-up: 5 years (range 1-12). Good performance status (PS) in most (only 9\% PS 2). Eighty-three percent were fully independent for ADL and 71\% for IADL. IADL most affected was the ability to drive/use public transport. Twenty-eight percent had geriatric syndromes and 23\% were classified as "frail". Increased age was associated with worsening PS (p=0.0001) and worsening function (ADL p<0.0001 and IADL p<0.0001). The study is remarkable for the high comorbidity index found in the elderly survivors. Median Charlson score was 2 (1-6). More than 75\% of the series had a score >/=4. Cardiovascular disease (hypertension) was the most prevalent comorbid condition. As an effect of this, the majority of patients were polymedicated (75\% took more than six drugs). Comorbidity was independent of functionality and age. CONCLUSIONS: Older patients with early breast cancer on follow-up have a high prevalence of comorbidity. In our series, function and independence were maintained. A selection bias cannot be excluded, as the fitter patients are those who usually continue with the follow-up, while those frail patients who do not continue because of their functional impairment are usually lost. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.
This article was published in Crit Rev Oncol Hematol
and referenced in Journal of Cancer Science & Therapy