title: Examining five- and ten-year survival in older women with breast cancer using cancer-specific geriatric assessment.
abstract: OBJECTIVE
  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 (HR(5-yrAllCauseFullyAdjusted)=1.87 [1.36-2.57], HR(10-yrAllCauseFullyAdjusted)=1.74 [1.35-2.15], HR(5-yrBreastCancerFullyAdjusted)=1.95 [1.18-3.20], HR(10-yrBreastCancerFullyAdjusted)=1.99 [1.21-3.28]).
  
  
  CONCLUSIONS
  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.
authors: Section of Geriatrics, Boston University Medical Center, 88 East Newton Street, Robinson Building, Boston, MA 02118, USA. kmclough@bu.edu
authors: Kerri M
authors: KM
authors: Clough-Gorr
authors: Soe Soe
authors: SS
authors: Thwin
authors: Andreas E
authors: AE
authors: Stuck
authors: Rebecca A
authors: RA
authors: Silliman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality*; D002423:Cause of Death; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D008137:Longitudinal Studies; D011237:Predictive Value of Tests; D016019:Survival Analysis