title: 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.
abstract: OBJECTIVE
  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 ≥70years newly diagnosed with early operable primary breast cancer was conducted aiming to explore the potential value of comprehensive geriatric assessment (CGA).
  
  
  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 6weeks and 6months 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.
  
  
  RESULTS
  CGA determined that increasing age (≥80years) (p=0.001), greater (≥4) comorbidity (p=0.022), greater number (≥4) of daily medications (p=0.002), and slower (≥19s) timed up and go (TUG) (p=0.016) score were significantly related to non-surgical treatment at 6weeks after diagnosis. Baseline QOL scores were generally good and they remained stable at 6months 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: School of Medicine, University of Nottingham, UK.
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Parks
authors.affiliation: School of Medicine, University of Nottingham, UK.
authors.forename: Louise
authors.initials: L
authors.lastname: Hall
authors.affiliation: School of Medicine, University of Nottingham, UK.
authors.forename: Siau-Wei
authors.initials: SW
authors.lastname: Tang
authors.affiliation: School of Health Sciences, University of Nottingham, UK.
authors.forename: Penny
authors.initials: P
authors.lastname: Howard
authors.affiliation: School of Medicine, University of Nottingham, UK.
authors.forename: Radhika
authors.initials: R
authors.lastname: Lakshmanan
authors.affiliation: Nottingham Breast Institute, Nottingham University Hospitals, UK.
authors.forename: Linda
authors.initials: L
authors.lastname: Winterbottom
authors.affiliation: Department of Oncology, Nottingham University Hospitals, UK.
authors.forename: David A
authors.initials: DA
authors.lastname: Morgan
authors.affiliation: School of Health Sciences, University of Nottingham, UK; School of Nursing, University of Buffalo, USA.
authors.forename: Davina
authors.initials: D
authors.lastname: Porock
authors.affiliation: School of Health Sciences, University of Nottingham, UK.
authors.forename: Karen
authors.initials: K
authors.lastname: Cox
authors.affiliation: School of Medicine, University of Nottingham, UK. Electronic address: kl.cheung@nottingham.ac.uk.
authors.forename: Kwok-Leung
authors.initials: KL
authors.lastname: Cheung
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000628:therapy*; D003657:Decision Making; D005240:Feasibility Studies; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D010865:Pilot Projects; D011446:Prospective Studies; D011788:Quality of Life; D012307:Risk Factors; D011795:Surveys and Questionnaires
keywords: CGA; Comprehensive geriatric assessment; Non-surgery; Primary endocrine therapy; Primary operable breast cancer; Quality of life; Surgery