Functional age vs chronological age1/2/2023 ![]() ![]() ![]() Frailty, a geriatric syndrome, is an independent risk factor for morbidity, mortality and increased LoS in hospital. The success of the NHS has resulted in a population which is aging, with those over 75 years of age undergoing surgery increasing. Surgical de-escalation procedures even in an-ambulatory setting are recognized as a feasible option in these patients to prevent or palliate breast or chest wall symptoms.īenefits and disadvantages from surgery only or coupled with adjuvant therapies for elderly women were analyzed in literature, outlining a growing need for a proper geriatric assessment and short-stay surgical programs which are feasible today owing to the availability of less invasive approaches. On the other hand, a higher mastectomy rate is still considered the standard treatment in older women with higher T2:T1 tumor ratio and greater difficulties to attend radiotherapy due to severe comorbidities. The surgery omission in elderlies and the preference for the primary endocrine treatment is associated with worse survival, especially in patients aged 80 years or over - a cohort with no specific recommendations concerning breast and axillary surgical procedures. Studies demonstrated that despite low-grade tumor types, lower incidence of axillary lymph node involvement, ER+ disease, and less aggressive tumor biology, elderly breast cancer patients often receive less than the standard-of-care when compared to their younger counterparts. The aim was to investigate the literature on breast surgical oncology in the older woman as a major therapeutic challenge: the 86 more consistent articles amongst 1440 potential citations according to PRISMA guidelines were retained. Undertreatment in daily practice is frequent and might have a negative impact on survival, as we report.īreast cancer treatment in elderly women remains a complex issue due to pre-existing comorbidities, therapy-related toxicities, and the lack of evidence-based data in this population, leading to both overtreatment and undertreatment. More importantly, assessing frailty (not to treat) is essential to be aware of the risk-benefit profile and the patient's well-informed willingness to be treated. Additionally, omission of surgery had a frailty-independent negative impact on overall survival (HR, 3.9 95% CI, 1.9–7.9).īC treatment in older adults should be individualized. We found a considerably high proportion (53.3%) of undertreatment, which had a frailty-independent negative impact on the 5-year survival (hazard ratio, 5.1 95% confidence interval, 2.1–12.5). Thirty-three patients (35.6%) died, of which 15 were from BC. A low-risk disease was not found (51.2% were N+), probably due to a late diagnosis (76.1% based on self-examination). The prevalence of frailty was discordant (G8, 41.9% fTRST, 74.2% GFI, 32.3%). The median age was 77 (range 70–94) years. In addition, we defined undertreatment and correlated its survival impact with frailty.Ī total of 92 patients were included in the study. Disease characteristics, treatment options, and causes of mortality were recorded during a 5-year follow-up. Three frailty screening tools (G8, fTRST, and GFI) and two functional status scales (Karnofsky performance score and Eastern Cooperative Oncology Group Performance Status) were applied. Our goal was to measure undertreatment and assess its impact on survival.Ĭonsecutive patients with BC aged 70 years or older were prospectively enrolled in 2014. The challenging assessment of aging idiosyncrasies and the scarce evidence of therapeutic guidelines can lead to undertreatment. The management of older adults with breast cancer (BC) remains controversial. #Functional age vs chronological age series#In this Series paper, we discuss the use of a geriatric assessment-based approach to cancer care, and provide clinicians with tools to better assess the risks and benefits of treatment to engage in shared decision making and provide better personalised care for older people with cancer. ![]() The geriatric assessment is a multidimensional tool that evaluates several domains, including physical function, cognition, nutrition, comorbidities, psychological status, and social support. By contrast, a geriatric assessment can provide a much more comprehensive understanding of the functional and physiological age of an older person with cancer. Chronological age alone is often a poor indicator of the physiological and functional status of older adults, and thus should not be the main factor guiding treatment decisions in oncology. As the worldwide population ages, oncologists are often required to make difficult and complex decisions regarding the treatment of older people (aged 65 years and older) with cancer. ![]()
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