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. ORCID: https://orcid.org/0000-0002-9782-2080, Edwards, Adrian ORCID: https://orcid.org/0000-0002-6228-4446, Robinson, Thompson G., Martin, Charlene, Chater, Tim, Pemberton, Kirsty J., Brennan, Alan, Leung Cheung, Kwok, Todd, Annaliza, Audisio, Riccardo A., Wright, Juliet, Green, Tracy, Revell, Deirdre, Gath, Jacqui, Horgan, Kieran, Holcombe, Chris, Winter, Matthew C., Naik, Jay, Parmeshwar, Rishi, Gosney, Margot A., Thompson, Alastair M., Wyld, Lynda and Ring, Alistair 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. 10.1016/j.radonc.2021.06.021

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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
Date Type:	Publication
Status:	Published
Schools:	Medicine
Publisher:	Elsevier
ISSN:	0167-8140
Date of First Compliant Deposit:	9 July 2021
Date of Acceptance:	9 June 2021
Last Modified:	06 Nov 2024 20:15
URI:	https://orca.cardiff.ac.uk/id/eprint/142497

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