Observational cohort study in older women with early breast cancer: use of radiation therapy and impact on health-related quality of life and mortality

Battisti, Nicolò Matteo Luca, Hatton, Matthew Q, Reed, Malcolm W R, Herbert, Esther, Morgan, Jenna L, Bradburn, Michael, Simcock, Richard, Walters, Stephen J, Collins, Karen A, Ward, Sue E, Holmes, Geoffrey R, Burton, Maria, Lifford, Kate J, Edwards, Adrian, Wright, Juliet and others, (2021) Observational cohort study in older women with early breast cancer: use of radiation therapy and impact on health-related quality of life and mortality. Radiotherapy and Oncology, 161. pp. 166-176. ISSN 0167-8140

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Abstract

Background
Radiotherapy reduces in-breast recurrence risk in early breast cancer (EBC) in older women. This benefit may be small and should be balanced against treatment effect and holistic patient assessment. This study described treatment patterns according to fitness and impact on health-related quality-of-life (HRQoL).

Methods
A multicentre, observational study of EBC patients aged ≥ 70 years, undergoing breast-conserving surgery (BCS) or mastectomy, was undertaken. Associations between radiotherapy use, surgery, clinico-pathological parameters, fitness based on geriatric parameters and treatment centre were determined. HRQoL was measured using the European Organisation for the Research and Treatment of Cancer (EORTC) questionnaires.

Results
In 2013–2018 2811 women in 56 UK study centres underwent surgery with a median follow-up of 52 months. On multivariable analysis, age and tumour risk predicted radiotherapy use. Among healthier patients (based on geriatric assessments) with high-risk tumours, 534/613 (87.1%) having BCS and 185/341 (54.2%) having mastectomy received radiotherapy. In less fit individuals with low-risk tumours undergoing BCS, 149/207 (72.0%) received radiotherapy. Radiotherapy effects on HRQoL domains, including breast symptoms and fatigue were seen, resolving by 18 months.

Conclusion
Radiotherapy use in EBC patients ≥ 70 years is affected by age and recurrence risk, whereas geriatric parameters have limited impact regardless of type of surgery. There was geographical variation in treatment, with some fit older women with high-risk tumours not receiving radiotherapy, and some older, low-risk, EBC patients receiving radiotherapy after BCS despite evidence of limited benefit. The impact on HRQoL is transient.

Item Type: Article
Keywords: Adjuvant radiotherapy, Breast cancer, Comorbidity, Frailty, Health-related quality of life, Older, Aged, Breast Neoplasms, Cohort Studies, Female, Humans, Mastectomy, Mastectomy, Segmental, Quality of Life, Radiotherapy, Adjuvant
Schools and Departments: Brighton and Sussex Medical School > Clinical and Experimental Medicine
SWORD Depositor: Mx Elements Account
Depositing User: Mx Elements Account
Date Deposited: 12 Nov 2021 08:42
Last Modified: 17 Jun 2022 01:00
URI: http://sro.sussex.ac.uk/id/eprint/102801

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