title: Use of Geriatric Assessment Tools in Selecting Therapies in Women Aged ≥70 Years With Hormone Receptor-Positive Early-Stage Breast Cancer: Preliminary Experience With a Quality Improvement Initiative.
abstract: To develop a multidisciplinary algorithmic approach to management of women aged ≥70 years with clinically staged T1N0 hormone receptor-positive breast cancer, including geriatric assessments predicting life expectancy and the likelihood of functional decline in the near future, in the context of a program-wide quality improvement initiative, to better select patients for therapeutic interventions.
  
  
  
  Two geriatric assessment tools, the Combined Lee-Schonberg Index and the Vulnerable Elderly Scale, were introduced into our clinical workflow to predict long-term mortality and likelihood of functional decline. Scores from these tools, along with patient preferences and clinical features, were incorporated into a preoperative algorithm addressing the use of sentinel lymph node biopsy (SLNB), and a postoperative algorithm addressing the use of adjuvant radiation therapy (RT).
  
  
  
  The algorithms were approved for use in August 2015. Twenty-four patients were identified by in-clinic screening and have been managed using the algorithms as a guide. Mean patient age was 80 years (range, 71-89 years). Per the preoperative algorithm, consideration of omission of SLNB was an option in 11 of 24 patients (46%), and in total 18 of 24 (75%) opted against SLNB. Per the postsurgical algorithm, consideration of omission of adjuvant RT was an option for 19 of 24 patients (79%), and in total 17 of 24 (71%) opted to forego RT.
  
  
  
  Incorporation of simple geriatric assessments seems to have had a marked impact on decision making regarding both surgical and adjuvant therapies for women aged ≥70 years with early-stage hormone-positive breast cancer compared with historical patterns, with ≥71% omission of both SLNB and adjuvant RT in patients managed according to an institutional quality improvement initiative.
authors.affiliation: Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland. Electronic address: jwrigh71@jhmi.edu.
authors.forename: Jean L
authors.initials: JL
authors.lastname: Wright
authors.affiliation: Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Arti
authors.initials: A
authors.lastname: Parekh
authors.affiliation: Division of Geriatric and Palliative Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Yao Yao
authors.initials: YY
authors.lastname: Pollock
authors.affiliation: Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Nancy
authors.initials: N
authors.lastname: Schoenborn
authors.affiliation: Department of Medical Oncology, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Smith
authors.affiliation: Department of Surgery, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Colette
authors.initials: C
authors.lastname: Magnant
authors.affiliation: Department of Medical Oncology, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Vered
authors.initials: V
authors.lastname: Stearns
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001943:Breast Neoplasms / Q000737:chemistry* / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D019583:Dose Fractionation, Radiation; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D008017:Life Expectancy; D017410:Practice Guidelines as Topic; D011379:Prognosis; D058996:Quality Improvement; D018714:Radiotherapy, Adjuvant; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; D021701:Sentinel Lymph Node Biopsy
chemical_list: D011960:Receptors, Estrogen; D011980:Receptors, Progesterone