Examining five-and ten-year survival in older women with breast cancer using cancer-specific geriatric assessment

Purpose: To examine five-and ten-year survival based on cancer-specific geriatric assessment (C-SGA) in older women with early stage breast cancer. Methods: We evaluated 660 women >= 65-years old diagnosed with stage I-IIIA primary breast cancer and attending physician permission to contact in four geographic regions in the United States of America (USA). Data were collected over ten-years of follow-up from consenting women's medical records, telephone interviews, National Death Index and Social Security Death Index. C-SGA was described by four domains using six measures: socio-demographic (financial resources); clinical (comorbidity, obesity); function (physical function limitations); and psychosocial (general mental health, social support). Survival from all-cause and breast-cancer-specific mortality and receipt of guideline-recommended therapy was assessed for different groups of subjects with C-SGA domain deficits (cut-off >= 3 deficits). Results: The proportion of women with >= 3 C-SGA deficits surviving ten-years was consistently statistically significantly lower (all-cause 26% versus 46% and breast-cancer-specific 76% versus 89%, p <= 0.04). The proportion significantly decreased as number of C-SGA deficits increased (linear trend p < 0.0001). Receipt of guideline-recommended therapy decreased with age but not consistently by number of C-SGA deficits. The all-cause and breast-cancer-specific death rate at five-and ten-years was consistently approximately two times higher in women with >= 3 C-SGA deficits even when fully adjusted for confounding factors (HR5-yrAllCauseFullyAdjusted = 1.87 [1.36-2.57], HR10(-yrAllCauseFullyAdjusted) = 1.74 [1.35-2.15], HR5-(yrBreastCancerFullyAdjusted) = 1.95 [1.18-3.20], HR10-(yrBreastCancerFullyAdjusted) = 1.99 [1.21-3.28]). Conclusion: Regardless of age and stage of disease, C-SGA predicts five-and ten-year all-cause and breast-cancer-specific survival in older women. Hence, C-SGA may provide an effective strategy to guide treatment decision-making and to identify risk factors for intervention. (C) 2011 Elsevier Ltd. All rights reserved.