263P - Omission of surgery in selected elderly patients with early breast cancer does not increase cancer specific mortality

Date 01 October 2012
Event ESMO Congress 2012
Session Poster presentation III
Topics Breast Cancer, Early Stage
Geriatric Oncology
Presenter Marije Hamaker
Authors M. Hamaker1, E. Bastiaannet2, C. Smorenburg3, G. Liefers2, S. De Rooij4, J.E.A. Portielje5
  • 1Geriatric Medicine, Diakonessenhuis, 3707HL - zeist/NL
  • 2Surgery, LUMC, Leiden/NL
  • 3Internal Medicine, Medisch Centrum Alkmaar, NL-1800 AM - Alkmaar/NL
  • 4Internal Medicine, AMC, Amsterdam/NL
  • 5Interne Geneeskunde, Hagaziekenhuis van Den Haag, NL-2545 CH - The Hague/NL

Abstract

Aim

to determine the clinical characteristics and cause of death for a multicentre cohort of elderly patinets with resectable breast cancer for whom surgery was omitted.

Methods

Chart review of 187 patients aged 75 years or older with early stage primary breast cancer, diagnosed at five centres in the Netherlands between 1990 and 2005 who did not receive primary surgery. Clinical, social, and functional characteristics as well as reason for omission of surgery were collected; comorbidity burden was scored using the Charlson index. Cause of death was retrieved from a national database containing death certificate data.

Results

Median age was 85.9 years (range 75.0-97.7 years). Median Charlson score was 1 (range 0-7). For 32% omission of surgery was at the patient's request; other reasons were age (4%), comorbidity (6%), overall health satus (5%), or not specified (53%). Thirteen patients did not receive any treatment (8%); all others received hormonal therapy. Seve patients (4%) required secondary surgical intervention due to disease progression (median time to surgery 1 year). By December 2010, 17 patients had died (95%); 34% died of breast cancer and for 21% of patients dying of other causes, breast cancer was mentioned as a potential underlying cause of death. For the remaining patients, breast cancer was not mentioned as a potential cause of death or as an underlying disease. Median survival was 2.1 years (range 0.2-10.7 years) and did not differ between patients dying of breast cancer versus all other causes of death (p = 0.9). Risk of dying of breast cancer decreased with increasing comorbidity (p = 0.06) while age, stage and receptor status were not associated with cancer specific mortaliyt.

Conclusion

Omission of surgery for elderly patients with early breast cancer may not increase cancer specific mortality and in a significant number of patients, breast cancer was not considered clinicaly relevant at the time of death. As in one-third of cases conservative treatment was at patient's request, future studies should focus on providing women with the information that they consider most relevant, such as quality of ife and functional outcomes, enabling well-informed decision making.

Disclosure

All authors have declared no conflicts of interest.