Treatment of elderly breast cancer patients in a breast center in India

Geriatric Breast Cancer: Staging, Molecular Surrogates, and Treatment. A Review & Meta-analysis

Breast cancer (BC) is one of the most frequent cancers in females across the globe. Treatment recommendations for BC patients are primarily driven by patient age, staging and tumor molecular subtype. Thus, we updated the general overview of BC staging, molecular surrogates, and treatment choices for women >70 years based on a systematic study encompassing the years 2013-2023. A PRISMA guidelines and PICO framework were followed, and relevant research articles were searched using different data bases (Web of Sciences, PubMed, MEDLINE, and Scopus). Mixed Methods Appraisal Tool was used for studies quality assessment. The research articles that made it into the systematic review were compiled using qualitative criteria. In the meanwhile, heterogeneity was determined using meta-analysis with RevMan 5.4. We applied a random effects model with a 0.05 significance level. Overall, there were 4151 research articles, after screening only 17 articles with 39,906 patients were included. Conclusion: Elderly patients with breast cancer should be treated differently in an adapted way. The treatment should not be the same worldwide due to different health systems. Molecular surrogates are different in geriatric patients. Surgery is the best option for treatment in this subset of patients. We need to have therapeutic decision appointments for elderly patients with breast cancer. The guidelines and medical authority should be used in the best decision.

A prospective case-control study of disability, quality of life, and functional impairment of shoulder movements after latissimus dorsi myocutaneous flap reconstruction in breast cancer patients

Objectives

Dysfunction of shoulder movements could be a limiting factor to the use of Latissimus dorsi (LD) flap. This study aimed to assess the impact of LD flap reconstruction on shoulder dysfunction and the quality of life.

Material and Methods

This study comprised 28 early breast cancer cases who underwent breast conserving surgery (BCS) with LD flap and 40 controls. Subjective and objective assessments were done a year later.

Results

Mild and moderate disability were found in 85.71% and 14.3% cases vs. 100% and 0% controls (p= 0.316) respectively. Physical and emotional functioning were 84.29 ± 5.61 and 66.67 ± 6.05 in cases vs. 86.67 ± 8.38 and 70.0 ± 6.84 in controls (p= 0.36, 0.23) respectively. Pain score in cases was 23.8 ± 15.6 vs. 12.17 ± 8.4 in controls (p= 0.018). LD muscle strength in extension was 4.39 ± 0.35 in cases vs. 4.88 ± 0.22 in controls (p <0.001), 4.43 ± 0.18 for adduction in cases vs. 4.65 ± 0.24 in controls (p= 0.006). ROM of shoulder in flexion was 151.61 ± 4.86° in cases and 153.88 ± 2.36° in controls (p= 0.08), 40.36 ± 3.52° in cases vs. 49.13 ± 1.86° in controls for extension (p <0.001), in abduction it was 150.54 ± 3.69° in cases vs. 150.00 ± 0.00° in controls (p= 0.518), in adduction was 30.89 ± 4.0° in cases vs. 38.13 ± 1.11° in controls (p <0.001), in external rotation was 73.57 ± 3.63° in cases vs. 77.63 ± 2.36° in controls (p <0.001), and internal rotation was 69.46 ± 3.56° in cases vs. 79.00 ± 1.26° in controls (p <0.001).

Conclusion

We conclude that functional impairment should not be a determining factor for LD flap in breast reconstruction surgery.

Survival Outcome and Predictors of Survival in Elderly Breast Cancer Patients following Curative Treatment

Anoop TMObjectives  The lack of data on management of elderly breast cancer patients' population makes most oncologists reluctant to treat them with the standard treatment protocols as advised for the younger patients. This study was done to identify the survival outcome and predictors of survival in elderly breast cancer patients treated with curative intent. Materials and Methods  Newly diagnosed patients with breast cancer aged more than 65 years who received treatment with curative intent were included. Disease-free survival (DFS) and overall survival were estimated using the Kaplan-Meier method. Survival curves were compared using log-rank test. Cox regression analysis was done to find out the predictors of DFS. Results  This study included 112 elderly breast cancer patients. In our patient population, 79 (70.5%) were less than or equal to 70 years of age and 33 (29.5%) were more than or equal to 70 years. Median age was 68 years. Charlson comorbidity index score was six and above in 31 (28.1) patients. Median DFS in our study was 46 months. Median DFS was not reached in patients less than or equal to 70 years of age, whereas it was 50 months (47-53) among patients more than or equal to 70 years of age, p -value-0.009. In univariate analysis, age more than or equal to 70 years and locally advanced breast cancer were the predictors of DFS with hazard ratio (HR) of 2.8 (1.2-6.69), p -value 0.013 and 2.9 (1.12-7.6), and 0.027, respectively. In multivariate analysis, age more than or equal to 70 years was the only significant predictors of DFS with HR of 2.8 (1.2-6.5) and p -value of 0.015. Conclusion  Standard curative intent treatment was well tolerable among elderly patents. Elderly age more than 70 years was a unique predictor of DFS. We need to incorporate tools to assess life expectancy and functional status that will help us predict toxicity of treatment and survival advantage more precisely.

Local and systemic therapy may be safely de-escalated in elderly breast cancer patients in China: A retrospective cohort study

Background

For elderly patients with breast cancer, the treatment strategy is still controversial. In China, preoperative axillary lymph node needle biopsy is not widely used, resulting in many patients receiving axillary lymph node dissection (ALND) directly. Our study aims to determine whether local and systemic therapy can be safely de-escalated in elderly breast cancer.

Methods

Patients aged ≥70 years were retrospectively enrolled from our institution’s medical records between May 2013 and July 2021. Groups were assigned according to local and systemic treatment regimens, and stratified analysis was performed by molecular subtypes. Univariate and multivariate survival analyses were used to compare the effects of different regimens on relapse-free survival (RFS).

Results

A total of 653 patients were enrolled for preliminary data analysis, and 563 patients were screened for survival analysis. The mean follow-up was 19 months (range, 1–82 months). Axillary lymph node metastases were pathologically confirmed in only 2.1% of cN0 cases and up to 97.1% of cN+ cases. In the aspect of breast surgery, RFS showed no significant difference between mastectomy and BCS group (p = 0.3078). As for axillary surgery, patients in the ALND group showed significantly better RFS than those in the sentinel lymph node biopsy (SLNB) group among pN0 patients (p = 0.0128). Among these cases, the proportion of cN+ in ALND was significantly higher than that in SLNB (6.4% vs. 0.4%, p = 0.002), which meant axillary lymph nodes (ALNs) of ALND patients were larger in imaging and more likely to be misdiagnosed as metastatic. With regard to adjuvant therapy, univariate and multivariate analyses showed that RFS in different comprehensive adjuvant regimens were similar especially among hormone receptor (HR)+/human epidermal growth factor receptor 2 (HER2)− subgroup where patients who did not receive any adjuvant therapy accounted for 15.7% (p > 0.05).

Conclusions

It is feasible to reduce some unnecessary local or systemic treatments for elderly breast cancer patients, especially in HR+/HER2− subtype. Multiple patient-related factors should be considered when making treatment plans.

Cancer in the older Indian population: Understanding the current context in an emerging economy

India is considered a demographically young country with over 65% of the population aged below 35 years. However, improvements in maternal and child health, and infectious diseases, have created a rapid epidemiological transition with an aging population (8.6% in 2011) with a projected increase (19% by 2050), equating to 104 million. In addition to the well-articulated issues surrounding the care of the older patients with cancer, the Indian context as an emerging economy provides additional social, political, economic and clinical challenges. This review addresses the key issues and possible solutions germane to both policymakers in India and other emerging economies. Extension of cancer prevention, equal, optimal treatment opportunities, and inclusion in clinical trials, akin to the younger population, must be encouraged. Various national health initiatives require effective implementation, to provide uniform, evidence-based, cancer care across India. Designated geriatric oncology departments, and required care at the primary healthcare level are essential.