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Del Barco S, Cotes-Sanchís A, Cavanagh M, Gironés-Sarrió R, de San Vicente BL, Galve-Calvo E, Servitja S. Strategies to enhance management of HER2-positive breast cancer in the elderly: an expert consensus perspective. Clin Transl Oncol 2025:10.1007/s12094-024-03838-1. [PMID: 39792239 DOI: 10.1007/s12094-024-03838-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Accepted: 12/19/2024] [Indexed: 01/12/2025]
Abstract
Therapeutic decision-making for older patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer highlights the importance of a comprehensive geriatric assessment (CGA). This assessment considers the functional status, comorbidities, and relevant conditions of the patient, and allows for an estimation of life expectancy, but it does not facilitate individualized treatment plans. There are also other challenges to consider related to the cardiac toxicity of the treatments and the under-representation of older patients in clinical trials. The Oncogeriatrics Section of the Spanish Society of Medical Oncology (Sociedad Española de Oncología Médica, SEOM), the Spanish Group for Breast Cancer Research (Grupo Español de Investigación en Cáncer de Mama, GEICAM) and the Spanish Group of Study, Treatment and other Experimental Strategies in Solid Tumours (Grupo Español de Estudio, Tratamiento y otras Estrategias Experimentales en Tumores Sólidos, SOLTI) have gathered an expert committee to evaluate the scientific evidence on the management of older patients with HER2-positive breast cancer and to establish recommendations based on a comprehensive review of the existing literature. These recommendations underscore the importance of individualizing treatment plans based on the patient's physical status and tolerability to maximize efficacy while minimizing toxicity. Emphasis is placed on adapting neoadjuvant and adjuvant therapies according to geriatric assessment and specific patient needs. A careful selection of treatment schedules for advanced stages is needed to improve survival and quality of life, assuming that scientific evidence in this age group is limited.
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Affiliation(s)
- Sonia Del Barco
- Department of Medical Oncology, Spanish Society of Medical Oncology (SEOM) Oncogeriatrics Section, Catalan Institute of Oncology (ICO), Doctor Josep, Trueta University Hospital, Avinguda de França, S/N, 17007, Girona, Spain.
| | - Almudena Cotes-Sanchís
- Medical Oncology Department Alicante, Spanish Society of Medical Oncology (SEOM) Oncogeriatrics Section, Elda Virgen de la Salud General University Hospital, Elda, Spain
| | - Mercedes Cavanagh
- Medical Oncology Department, Faculty of Biomedical and Health Sciences, Spanish Society of Medical Oncology (SEOM) Oncogeriatrics Section, Getafe University Hospital, Madrid European University, Madrid, Spain
| | - Regina Gironés-Sarrió
- Medical Oncology Department, Spanish Society of Medical Oncology (SEOM) Oncogeriatrics Section, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Borja López de San Vicente
- Medical Oncology Department, Spanish Society of Medical Oncology (SEOM) Oncogeriatrics Section, Basurto University Hospital, Bilbao, Spain
| | - Elena Galve-Calvo
- Medical Oncology Department, Spanish Group of Study, Treatment and Other Experimental Strategies in Solid Tumours (SOLTI), Basurto University Hospital, Bilbao, Spain
| | - Sonia Servitja
- Medical Oncology Department, Hospital del Mar, Parc de Salut Mar, Spanish Group for Breast Cancer Research (GEICAM), Barcelona, Spain
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Nak D, Kivrak M. Mastectomy, HER2 Receptor Positivity, NPI, Late Stage and Luminal B-Type Tumor as Poor Prognostic Factors in Geriatric Patients with Breast Cancer. Diagnostics (Basel) 2024; 15:13. [PMID: 39795542 PMCID: PMC11720289 DOI: 10.3390/diagnostics15010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2024] [Revised: 12/19/2024] [Accepted: 12/23/2024] [Indexed: 01/13/2025] Open
Abstract
Background/Objectives: This study aims to explore the risk factors associated with poor survival outcomes in geriatric female patients with breast cancer. Methods: This study utilized data from the METABRIC database to evaluate the risk factors associated with poor survival outcomes among geriatric breast cancer patients. A total of 2909 female patients, 766 of whom were geriatric, were included in the study. The effects of the type of surgery; breast cancer types; cellularity; Estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) status; molecular class; axillary lymph nodes; Nottingham prognostic index (NPI); status of receiving systemic chemotherapy (SCT), hormone therapy (HT), and radiotherapy (RT); tumor size and tumor on overall survival (OS); and progression-free status (PFS) of geriatric patients were investigated. Additionally, the disease-specific survival of geriatric patients was compared with other patients. Results: HER2 receptor positivity, advanced-stage tumors (T3-T4), a high NPI, and Luminal B subtypes were significant predictors of worse outcomes. Conversely, Luminal A tumors, associated with favorable hormonal responsiveness, demonstrated the best progression-free survival (PFS). HER2-positive patients exhibited a poorer PFS compared to their HER2-negative counterparts, underscoring the need for careful management of aggressive subtypes in older adults. Additionally, patients undergoing mastectomy were less likely to receive adjuvant therapies, contributing to inferior outcomes compared to breast-conserving surgery (BCS). Conclusions: Mastectomy, HER2 positivity, high NPI, advanced stages, and Luminal B tumors are significant prognostic factors in geriatric breast cancer patients.
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Affiliation(s)
- Demet Nak
- Department of Nuclear Medicine, Education and Training Hospital, Recep Tayyip Erdoğan University, 53020 Rize, Turkey;
| | - Mehmet Kivrak
- Department of Biostatistics and Medical Informatics, Division of Basic Medical Sciences, Faculty of Medicine, Recep Tayyip Erdoğan University, 53020 Rize, Turkey
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Hipólito-Reis H, Santos J, Almeida P, Teixeira L, Rodrigues F, Tavares NT, Rodrigues D, Almeida J, Osório F. Implementation of an Oncogeriatric Unit for Frail Older Patients with Breast Cancer: Preliminary Results. Curr Oncol 2024; 31:7809-7819. [PMID: 39727698 DOI: 10.3390/curroncol31120575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Revised: 11/15/2024] [Accepted: 12/02/2024] [Indexed: 12/28/2024] Open
Abstract
(1) Background: Breast cancer (BC) has a high incidence in Europe, particularly in older adults. Traditionally under-represented in clinical trials, this age group is often undertreated due to ageism. This study aims to characterize frail older adults (≥70 years) with BC based on a comprehensive geriatric assessment, to guide individualized treatment decision-making. (2) Methods: A descriptive analysis of older adults with BC treated from January 2021 to December 2022 was performed. Data were analyzed based on anonymized electronic medical records. (3) Results: Of 123 patients (mean age 84.0 ± 5.6 years), 122 (99.2%) were women. The mean G8 screening score was 12.1 ± 2.5. Most had functional dependence (69.9% Barthel Index, 81.3% Lawton/Brody Scale) and a moderate-to-high risk of falling (76.4% Tinetti index). Cognitive impairment and malnutrition risk were present in 15.4% and 30.1%, respectively. Prehabilitation inclusive strategies led to adapted treatment in 55.3% of cases. Endocrine therapy, surgery, radiotherapy, and chemotherapy was used in 99.2%, 56.1%, 35.0%, and 8.9% of patients, respectively. (4) Conclusions: Our comprehensive oncogeriatric strategy promotes personalized oncologic treatment, improves outcomes by addressing frailty, and enhances treatment tolerability in older patients with BC, validating the expansion of this combined team approach to other cancer types and institutions.
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Affiliation(s)
- Helena Hipólito-Reis
- Department of Internal Medicine, São João University Hospital (ULS São João), 4200-319 Porto, Portugal
| | - Joana Santos
- Department of Internal Medicine, São João University Hospital (ULS São João), 4200-319 Porto, Portugal
| | - Paulo Almeida
- Department of Internal Medicine, São João University Hospital (ULS São João), 4200-319 Porto, Portugal
| | - Luciana Teixeira
- Department of Nutrition, São João University Hospital (ULS São João), 4200-319 Porto, Portugal
| | - Fernando Rodrigues
- Hospital Epidemiology Center, São João University Hospital (ULS São João), 4200-319 Porto, Portugal
| | - Nuno Teixeira Tavares
- Department of Oncology, São João University Hospital (ULS São João), 4200-319 Porto, Portugal
- Breast Center, São João University Hospital (ULS São João), 4200-319 Porto, Portugal
| | - Darlene Rodrigues
- Department of Behavioural Sciences, Institute of Biomedical Sciences Abel Salazar, 4050-313 Porto, Portugal
- RISE@CINTESIS-Center for Health Technology and Services Research, 4200-450 Porto, Portugal
| | - Jorge Almeida
- Department of Internal Medicine, São João University Hospital (ULS São João), 4200-319 Porto, Portugal
- Department of Medicine, Faculty of Medicine, University of Porto, 4099-002 Porto, Portugal
| | - Fernando Osório
- Breast Center, São João University Hospital (ULS São João), 4200-319 Porto, Portugal
- RISE@CINTESIS-Center for Health Technology and Services Research, 4200-450 Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, 4099-002 Porto, Portugal
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Seaman AT, Rowland JH, Werts SJ, Tam RM, Torres TK, Hucek FA, Wickersham KE, Fairman CM, Patel HD, Thomson CA, Hebert JR, Friedman DB. Examining provider perceptions and practices for comprehensive geriatric assessment among cancer survivors: a qualitative study with an implementation science focus. FRONTIERS IN AGING 2023; 4:1305922. [PMID: 38111517 PMCID: PMC10725930 DOI: 10.3389/fragi.2023.1305922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/21/2023] [Indexed: 12/20/2023]
Abstract
Introduction: Cancer rates increase with age, and older cancer survivors have unique medical care needs, making assessment of health status and identification of appropriate supportive resources key to delivery of optimal cancer care. Comprehensive geriatric assessments (CGAs) help determine an older person's functional capabilities as cancer care providers plan treatment and follow-up care. Despite its proven utility, research on implementation of CGA is lacking. Methods: Guided by a qualitative description approach and through interviews with primary care providers and oncologists, our goal was to better understand barriers and facilitators of CGA use and identify training and support needs for implementation. Participants were identified through Cancer Prevention and Control Research Network partner listservs and a national cancer and aging organization. Potential interviewees, contacted via email, were provided with a description of the study purpose. Eight semi-structured interviews were conducted via Zoom, recorded, and transcribed verbatim by a professional transcription service. The interview guide explored providers' knowledge and use of CGAs. For codebook development, three representative transcripts were independently reviewed and coded by four team members. The interpretive process involved reflecting, transcribing, coding, and searching for and identifying themes. Results: Providers shared that, while it would be ideal to administer CGAs with all new patients, they were not always able to do this. Instead, they used brief screening tools or portions of CGAs, or both. There was variability in how CGA domains were assessed; however, all considered CGAs useful and they communicated with patients about their benefits. Identified facilitators of implementation included having clinic champions, an interdisciplinary care team to assist with implementation and referrals for intervention, and institutional resources and buy-in. Barriers noted included limited staff capacity and competing demands on time, provider inexperience, and misaligned institutional priorities. Discussion: Findings can guide solutions for improving the broader and more systematic use of CGAs in the care of older cancer patients. Uptake of processes like CGA to better identify those at risk of poor outcomes and intervening early to modify treatments are critical to maximize the health of the growing population of older cancer survivors living through and beyond their disease.
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Affiliation(s)
- Aaron T. Seaman
- Department of Internal Medicine - General Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
| | - Julia H. Rowland
- Smith Center for Healing and the Arts, Washington, DC, United States
| | - Samantha J. Werts
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
- University of Arizona Cancer Center, Tucson, AZ, United States
| | - Rowena M. Tam
- Physical Therapy Program, School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, United States
- Herbert Wertheim School of Public Health and Human Longevity Science, UC San Diego, San Diego, CA, United States
| | - Tara K. Torres
- University of Arizona Cancer Center, Tucson, AZ, United States
- Department of Psychology, College of Science, University of Arizona, Tucson, AZ, United States
| | - Freda Allyson Hucek
- Office for the Study of Aging, Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Karen E. Wickersham
- College of Nursing, University of South Carolina, Columbia, SC, United States
| | - Ciaran M. Fairman
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Hiten D. Patel
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Cynthia A. Thomson
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
- University of Arizona Cancer Center, Tucson, AZ, United States
| | - James R. Hebert
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Daniela B. Friedman
- Office for the Study of Aging, Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
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