Abstract P6-12-11: Functional assessment in early breast cancer in older patients: The FABIO study
Authors: Phillips I , Sinha R , Fatz D , Ring A 
Published: May 2016

Introduction: More than a third of breast cancer diagnoses are made in women aged 70 years or older at the time of diagnosis. Epidemiological studies and practice surveys from the US and Europe have demonstrated lower rates of use of adjuvant chemotherapy and radiotherapy in older women with early breast cancer. It is not clear whether this is due to objective health problems mitigating the benefit of such therapies and increasing the risk of side-effects, or whether decisions are being made on the basis of age bias alone.A prospective cohort study was set-up to describe older patients' fitness according to a Comprehensive Geriatric Assessment (CGA) to investigate if fitness could explain apparent variations from standard care.

Methods: Women aged 70 or over diagnosed with early breast cancer were enrolled. Demographic and tumour details were recorded and patients underwent a CGA which evaluated: cognition (6-Cognitive Impairment Test:6-CIT), functional status (Activities of Daily Living [ADL], Instrumental Activities of Daily Living [IADL], Vulnerable Elders Score-13 [VES-13]), co-morbidities (Charlson co-morbidity index), anaesthetic fitness (ASA grade) and performance status (WHO). All patients also completed a G8 screening score. A predetermined threshold for defining patients as "unfit" (patients who failed one or more elements of the CGA) or "fit" was set for the purposes of this analysis.

Results: Two hundred and ninety-two patients were recruited, of whom 36% were aged 70-74, 54% 75-84 and 10% were aged 85 or over. Twenty-six percent of patients had node positive breast cancer, 29% had high grade tumours, 91% oestrogen receptor positive disease and 12% HER2 positive breast cancer. A full CGA was available for 212 patients. WHO performance status was 0 (42%), 1 (43%) and 2 or more (16%). VES-13 score was 3 or more (associated with functional decline) in 49%. G8 score was &lt; 14 (predictive of failing a CGA) in 56%. Eight-seven percent and 75% were independent in ADLs and IADLs respectively. Seventy-nine percent of patients has a 6-CIT score of 0-7 (normal). Charlson co-morbidity index was 0 (70%), 1(18%) and 2 or more (12%). According to the predetermined threshold: 170 (80%) were defined as unfit and 42 (20%) defined as fit.

One hundred and fifty-three patients underwent breast conserving surgery, 91% of those who had breast conserving treatment and were fit recieved adjuvant radiotherapy. Eighty-two patients had disease at high risk of recurrence meriting consideration of adjuvant chemotherapy (oestrogen receptor negative, HER2 positive, node positive, grade 3). Eighty-three percent of those with high risk disease who were fit received adjuvant chemotherapy.

Discussion: Many patients aged 70 years or older have deficits in a CGA which may indicate a higher risk of death from competing causes, functional decline and increased risks of toxicity, despite an apparently good performance status. Overall the rates of adjuvant chemotherapy use were low (consistent with previous literature). However the majority of patients with high risk disease who were fit received adjuvant chemotherapy, contrasting with the perception that older patients may be being denied access to treatment on the basis of age alone.

Citation Format: Phillips I, Sinha R, Fatz D, Ring A. Functional assessment in early breast cancer in older patients: The FABIO study. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-12-11.