Research Article| Volume 6, ISSUE 1, P46-51, January 2015

The potential value of comprehensive geriatric assessment in evaluating older women with primary operable breast cancer undergoing surgery or non-operative treatment — A pilot study

Published:September 26, 2014DOI:



      Breast cancer in older women raises a number of discrete issues, including how healthcare professionals can best decide which patients are candidates for surgery. A pilot study involving women aged ≥70 years newly diagnosed with early operable primary breast cancer was conducted aiming to explore the potential value of comprehensive geriatric assessment (CGA).

      Materials and Methods

      Decision of primary treatment followed consultation with the clinical team and was not guided by any aspect of this study. CGA, using a validated cancer-specific tool, was conducted within 6 weeks and 6 months after diagnosis, complemented by formal measures of quality of life (QOL) (using EORTC QLQ-C30 and QLQ-BR23) and semi-structured interviews. A total of 47 female patients with a new diagnosis of clinically early (stage 1 or 2; cT0-2N0-1M0) operable primary breast cancer proven histologically, were recruited.


      CGA determined that increasing age (≥80 years) (p = 0.001), greater (≥4) comorbidity (p = 0.022), greater number (≥4) of daily medications (p = 0.002), and slower (≥19 s) timed up and go (TUG) (p = 0.016) score were significantly related to non-surgical treatment at 6 weeks after diagnosis.
      Baseline QOL scores were generally good and they remained stable at 6 months follow-up. As opposed to CGA, there was no correlation between QOL scores and the treatment modality identified. Semi-structured interviews identified themes consistent with findings from QOL assessment.


      The pilot study confirmed the feasibility of conducting CGA in a research setting which appeared to have value in assessing this patient population. More data will be required to definitively identify the components for geriatric assessment in this setting. The study has now extended into two more centres.


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        • Cancer Research UK
        Breast cancer incidence statistics: Cancer Research UK [online].
        (Available at:) ([10th April 2013])
        • Syed B.M.
        • Green A.R.
        • Paish E.C.
        • Soria D.
        • Garibaldi J.
        • Morgan L.
        • et al.
        Biology of primary breast cancer in older women treated by surgery: with correlation with long-term clinical outcome and comparison with their younger counterparts.
        Br J Cancer. Mar 2013; 108: 1042-1051
        • Diab S.G.
        • Elledge R.M.
        • et al.
        Tumor characteristics and clinical outcome of elderly women with breast cancer.
        J Natl Cancer Inst. 2000; 92: 550
        • Martin F.
        Comprehensive assessment for the older frail person in hospital [online]. British Geriatrics Society.
        (Available at:) ([10th April 2013])
        • Extermann M.
        • Aapro M.
        • Bernabei R.
        • Cohen H.J.
        • Droz J.P.
        • Lichtman S.
        • et al.
        Use of comprehensive geriatirc assessment in older cancer patients: recommedations from the task force on CGA of the International Society of Geriatric Oncology (SIOG).
        Crit Rev Oncol Hematol. Sep 2005; 55: 241-252
        • Parks R.M.
        • Lakshmanan R.
        • Winterbottom L.
        • Morgan D.A.L.
        • Cox K.
        • Cheung K.L.
        Comprehensive geriatric assessment for older women with early breast cancer — a systematic review of literature.
        World J Surg Oncol. May 2013; 10: 88
        • Extermann M.
        • Hurria A.
        Comprehensive geriatric assessment for older patients with cancer.
        J Clin Oncol. May 22 2007; 25: 1824-1831
        • Badgwell B.
        • Stanley J.
        • Chang G.J.
        • Katz M.H.
        • Lin H.Y.
        • Ning J.
        • et al.
        Comprehensive geriatric assessment of risk factors associated with adverse outcomes and resource utilization in cancer patients undergoing abdominal surgery.
        J Surg Oncol. Sept 2013; 108: 182-186
        • Marchesi F.
        • Cenfra N.
        • Altomare L.
        • Dessanti M.L.
        • Mecarocci S.
        • Cerchiara e
        • et al.
        A retrospective study on 73 elderly patients (≥75 years) with aggressive B-cell non Hodgkin lymphoma: a clinical significant of treatment intensity and comprehensive geriatric assessment.
        J Geriatr Oncol. Jul 2013; 4: 242-248
        • Syed B.M.
        • Johnston S.J.
        • Wong D.W.
        • Green A.R.
        • Winterbottom L.
        • Kennedy H.
        • et al.
        Long-term (37 years) clinical outcome of older women with early operable primary breast cancer managed in a dedicated clinic.
        Ann Oncol. Jun 2012; 23: 1465-1471
        • Hurria A.
        • Gupta S.
        • Zaurderer M.
        • Zuckerman E.L.
        • Cohen H.J.
        • Muss H.
        Developing a cancer-specific geriatric assessment: a feasibility study.
        Cancer. 2005; 104: 1998-2005
        • Aaronson N.K.
        • Ahmedzai S.
        • Bergman B.
        • Bullinger M.
        • Cull A.
        • Duez N.J.
        • et al.
        The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology.
        J Natl Cancer Ist. Mar 1993; 85: 365-376
        • Fayers P.M.
        • Aaronson N.K.
        • Bjordal K.
        • Groenvold M.
        • Curran D.
        • Bottomley A.
        • et al.
        The EORTC QLQ-C3 — scoring manual.
        in: 3rd edition. European Organisation for Research and Treatment of Cancer, Brussels2001
        • Muss H.B.
        Coming of age: breast cancer in seniors.
        Oncologist. Nov 2010; 15: 57-65
        • Yancik R.
        • Wesley M.N.
        • Ries L.A.
        • Havlik R.J.
        • Edwards B.K.
        • Yates J.W.
        Effect of age and comorbidity in postmenopausal breast cancer patients aged 55 years and older.
        JAMA. Feb 2001; 285: 885-892
        • Werrett G.C.
        Anaesthesia and diabetes mellitus [online]. Anaesthesia UK.
        (Available at:) ([10th April 2013])
        • Patient UK
        General anaesthesia [online]. Patient UK.
        (Available at:) ([10th April 2013])
        • Bekker A.Y.
        • Weeks E.J.
        Cognitive function after anaesthesia in the elderly.
        Best Pract Res Clinl Anaesthesiol. Jun 2003; 17: 259-272
        • The Association of Anaesthetists of Great Britain and Ireland
        Anaesthesia and peri-operative care of the elderly [online]. The Association of Anaesthetists of Great Britain and Ireland.
        (Available at:) ([10th April 2013])
        • Platzer H.
        Post-operative confusion in the elderly — a literature review.
        Int J Nurs Stud. 1989; 26: 369-379
        • Hind D.
        • Wyld L.
        • Reed M.W.
        Surgery, with or without tamoxifen, vs tamoxifen alone for older women with operable breast cancer: Cochrane review.
        Br J Cancer. Apr 2007; 96: 1025-1029
        • Keegan T.H.
        • Milne R.L.
        • Andrulis I.L.
        • Chang E.T.
        • Sangaramoorthy M.
        • Philips K.A.
        • et al.
        Past recreational physical activity, body size, and all-cause mortality following breast cancer diagnosis: results from the Breast Cancer Family Registry.
        Breast Cancer Res Treat. Sep 2010; 123: 531-542
        • Holmes M.D.
        • Chen W.Y.
        • Feskanich D.
        • Kroenke C.H.
        • Colditz G.A.
        Physical activity and survival after breast cancer diagnosis.
        JAMA. May 2005; 293: 2479-2486
        • Audisio R.A.
        • van Leeuwen B.
        When reporting on older patients with cancer, frailty information is needed.
        Ann Surg Oncol. Jan 2011; 18: 4-5
        • Mandelblatt J.
        • Figueiredo M.
        • Cullen J.
        Outcomes and quality of life following breast cancer treatment in older women: when, why, how much, and what do women want?.
        Health Qual Life Outcomes. Sep 2003; 1: 45
        • Mandelblatt J.S.
        • Edge S.B.
        • Meropol N.J.
        • Seni R.
        • Tsangaris T.
        • Grey L.
        • et al.
        Predictors of long-term outcomes in older breast cancer survivors: perceptions versus patterns of care.
        J Clin Oncol. Mar 2003; 21: 855-863
        • Perkins E.A.
        • Small B.J.
        • Balducci L.
        • Extermann M.
        • Robb C.
        • We Haley
        Individual differences in well-being in older breast cancer survivors.
        Crit Rev Oncol Hematol. Apr 2007; 62: 74-83
        • Koch L.
        • Jansen L.
        • Herrmann A.
        • Stegmaier C.
        • Holleczek B.
        • Singer S.
        • et al.
        Quality of life in long-term breast cancer survivors — a 10-year longitudinal population-based study.
        Acta Oncol. Aug 2013; 52: 1119-1128
        • Husain L.S.
        • Collins K.
        • Reed M.
        • Wyld L.
        Choices in cancer treatment: a qualitative study of the older women's (>70 years) perspective.
        Psychoongology. Apr 2008; 17: 410-416
        • Lavelle K.
        • Moran A.
        • Howell A.
        • Bundred N.
        • Campbell M.
        • Todd C.
        Older women with operable breast cancer are less likely to have surgery.
        Br J Surg. Oct 2007; 94: 1209-1215
        • Whitehead S.
        • Lavelle K.
        Cancer survivors' views and preferences for physical activity.
        Qual Health Res. Jul 2009; 19: 894-906