Abstract P5-03-07: The measurement of gait speed: An easy way to select older patients with breast cancer for an adapted therapeutic decision making
Authors: Pamoukdjian F , Bricou A , Boudabous H , Sebbane G , Zelek L 
Published: March 2017

Background: Despite recommendations about the adaptation of therapeutic decision making by the International Society of Geriatric Oncology, there is no guidelines concerning breast cancer in older patients for whom a therapeutic decision making should be adapted. Currently, the G8 index ≤ 14/17 is recommended for patients aged 70 and over before a therapeutic decision making to select patients with a potential frailty. Moreover, gait speed (GS) at the threshold of 1 m/s has been reported in a recent review to identify complications associated with frailty in older outpatients. Indeed, these patients could experience poor outcomes with cancer treatments. For these patients, it is expected that they could not have a standardized decision. We aimed to assess the geriatric profil of older patients with breast cancer for whom a therapeutic decision making was adapted.

Methods: 64 outpatients with breast cancer aged 65 and over were prospectively and consecutively included between November 2013 and April 2016, in two teaching hospitals in a Paris suburb (France). All patients had a G8 index, measurement of gait speed over a short distance (4m) and a multidimensional geriatric assessment before therapeutic decision making. An adapted therapeutic decision making was defined if it not followed treatment recommendations based on tumor characteristics (pTNM, grade, status of hormonal receptors, HER2 status, Ki67 index). A univariate and multivariate analysis by using a logistic regression with a stepwise procedure were performed in all patients with an adapted therapeutic decision. Two models were created to assess the value of G8 index and GS. All variables with P &lt; 0.20 were included in both multivariate models. All tests were two sided significant at 0.05. Informed consent was obtained from studied patients prior inclusion. This study was approved by a local committee ethic.

Results: 67% (n=43) of patients had an adapted treatment with a mean age of 82.6 +/- 5.7 years (67-95). Of these patients, 33 had an invasive ductal carcinoma, 23 lymph nod extension, 11 metastatic disease. The mean tumor size was 30.4 +/- 15.4mm. 37 patients had a SBR ≥ 2, 39 positive hormonal receptors, 5 positive HER2 status. The mean KI67 index was 24.2 +/- 20%. 37 received hormonotherapy, 18 surgery, 16 radiotherapy, 5 chemotherapy. Most of these patients (53.5%) had ECOG-PS ≤ 1, 39 G8 index ≤ 14 and 36 GS &lt; 1 m/s. In the first model, GS &lt; 1 m/s was the only variable significantly and independently associated with adapted treatment (aOR=5.65, 95%CI: 1.78-19.31, P=0.003). In the second model, at least one severe comorbidity (CIRSG grade III, aOR=4.52, 95%CI: 1.30-17.84, P=0.02) and cognitive impairment (MMSE&lt;24/30, aOR=4.60, 95%CI: 1.32-17.97, P=0.01) were the only variables significantly and independently associated with adapted treatment. In the two models, G8 index was not significantly associated with adapted treatment.

Conclusion: A slow gait speed &lt; 1 m/s could be used as a screening test to select older patients with breast cancer for an adapted therapeutic decision making.

Citation Format: Pamoukdjian F, Bricou A, Boudabous H, Sebbane G, Zelek L. The measurement of gait speed: An easy way to select older patients with breast cancer for an adapted therapeutic decision making [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-03-07.