title: Management of primary metastatic breast cancer in elderly patients--an international comparison of oncogeriatric versus standard care.
abstract: BACKGROUND
  An oncogeriatric approach may affect management of elderly patients with breast cancer. However, little is known about oncogeriatric care in the metastatic setting. Therefore, we performed an international comparison of management of elderly patients with primary metastatic disease who were treated in two different care settings.
  
  
  METHODS
  Patients who were ≥70years at diagnosis of primary metastatic disease were eligible. The first cohort comprised a population-based cohort of 104 patients (Comprehensive Cancer Center West, The Netherlands), who all received standard care. The second cohort comprised a hospital-based cohort of 42 patients (H. Lee Moffitt Cancer Center, Florida, United States), who all received oncogeriatric care.
  
  
  RESULTS
  No large differences in patient and tumor characteristics were observed between both cohorts. Most patients in the standard care cohort received systemic therapy as primary therapy, whereas most patients in the oncogeriatric cohort received a combination of systemic and local therapy. Patients in the standard care cohort received fewer lines of treatment (mean number of treatments 2.1 vs. 3.6, p<0.001), and particularly received less breast surgery, chemotherapy, and trastuzumab. Three-year overall mortality was 71% (95% CI: 61-83%) as compared to 58% (95% CI: 42-75%) among patients in the oncogeriatric care cohort (multivariable HR: 1.59 [95% CI: 0.88-2.87], p=0.125).
  
  
  CONCLUSIONS
  In primary metastatic breast cancer, oncogeriatric care intensifies treatment and might improve survival in elderly patients. Future studies on a larger scale should investigate the potential for improved survival, and whether this is accompanied by a better (preservation of) quality of life and functional status.
authors.affiliation: Department of Surgical Oncology, Leiden University Medical Center, Leiden, The Netherlands; Department of Geriatrics and Gerontology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Willemien
authors.initials: W
authors.lastname: van de Water
authors.affiliation: Department of Surgical Oncology, Leiden University Medical Center, Leiden, The Netherlands; Department of Geriatrics and Gerontology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Esther
authors.initials: E
authors.lastname: Bastiaannet
authors.affiliation: Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Egan
authors.affiliation: Department of Geriatrics and Gerontology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Anton J M
authors.initials: AJ
authors.lastname: de Craen
authors.affiliation: Department of Geriatrics and Gerontology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Rudi G J
authors.initials: RG
authors.lastname: Westendorp
authors.affiliation: Department of Senior Adult Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States.
authors.forename: Lodovico
authors.initials: L
authors.lastname: Balducci
authors.affiliation: Department of Surgical Oncology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Cornelis J H
authors.initials: CJ
authors.lastname: van de Velde
authors.affiliation: Department of Surgical Oncology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Gerrit-Jan
authors.initials: GJ
authors.lastname: Liefers
authors.affiliation: Department of Senior Adult Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States. Electronic address: Martine.Extermann@moffitt.org.
authors.forename: Martine
authors.initials: M
authors.lastname: Extermann
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000401:mortality / Q000628:therapy*; D015331:Cohort Studies; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006299:Health Services for the Aged / Q000458:organization & administration*; D006801:Humans; D009362:Neoplasm Metastasis; D011788:Quality of Life; D016896:Treatment Outcome
keywords: Breast cancer; Geriatric oncology; Oncogeriatric care; Primary metastatic