Adjuvant treatment decisions among adults aged 65 years and older with early-stage hormone receptor positive breast cancer seen in a simple multidisciplinary clinic versus standard consultation.

Autor: English K; The Johns Hopkins Department of Radiation Oncology, 401 North Broadway, Weinberg Building, Suite 1440, Baltimore, MD 21287, United States of America., Alcorn SR; The Johns Hopkins Department of Radiation Oncology, 401 North Broadway, Weinberg Building, Suite 1440, Baltimore, MD 21287, United States of America., Tran HT; The Johns Hopkins Department of Radiation Oncology, 401 North Broadway, Weinberg Building, Suite 1440, Baltimore, MD 21287, United States of America., Smith KL; The Johns Hopkins Department of Radiation Oncology, 401 North Broadway, Weinberg Building, Suite 1440, Baltimore, MD 21287, United States of America., Wilkinson M; The Johns Hopkins Department of Radiation Oncology, 401 North Broadway, Weinberg Building, Suite 1440, Baltimore, MD 21287, United States of America., Hirose KT; The Johns Hopkins Department of Radiation Oncology, 401 North Broadway, Weinberg Building, Suite 1440, Baltimore, MD 21287, United States of America., O'Donnell M; The Johns Hopkins Department of Radiation Oncology, 401 North Broadway, Weinberg Building, Suite 1440, Baltimore, MD 21287, United States of America., Croog V; The Johns Hopkins Department of Radiation Oncology, 401 North Broadway, Weinberg Building, Suite 1440, Baltimore, MD 21287, United States of America., Wright JL; The Johns Hopkins Department of Radiation Oncology, 401 North Broadway, Weinberg Building, Suite 1440, Baltimore, MD 21287, United States of America. Electronic address: Jwrigh71@jhmi.edu.
Jazyk: angličtina
Zdroj: Journal of geriatric oncology [J Geriatr Oncol] 2023 May; Vol. 14 (4), pp. 101503. Date of Electronic Publication: 2023 Apr 29.
DOI: 10.1016/j.jgo.2023.101503
Abstrakt: Introduction: Randomized studies support de-escalation of adjuvant therapy for a target population of older adults ≥65 years with stage I, estrogen-receptor (ER) positive breast cancer after breast conserving surgery. We sought to evaluate the impact of a simplified multidisciplinary clinic (s-MDC) in this population by comparing treatment patterns and patient perceptions of adjuvant radiation therapy (RT) and hormone therapy (HT) between patients seen in s-MDC vs. standard consultations.
Materials and Methods: Medical records were retrospectively reviewed for patients in the above target population who underwent surgery between August 2020 and May 2022 at our institution. Two cohorts were included: (1) patients seen in s-MDC, and (2) patients seen in standard clinic separately by medical and radiation oncology (non-s-MDC cohort). The non-s-MDC patients declined, could not attend, and/or were not referred to the s-MDC. Patients in the s-MDC cohort were prospectively administered validated questionnaires to evaluate patient reported data including the Decision Autonomy Preference Scale (DAPS), e-Prognosis, and Medical Maximizing-Minimizing Scale (MMS). Chi square, t-tests, and non-parametric equivalents compared demographics, and logistic regression evaluated RT and HT use and survey score outcomes between cohorts.
Results: A total of 127 patients met inclusion criteria, with 33 s-MDC and 94 non-s-MDC patients. There was no difference between the cohorts in age, margin status, histology, grade, or focality. In the s-MDC cohort there were significantly more patients without sentinel lymph node biopsy (71.3% vs 42.4%, p = 0.003) and mean tumor size was smaller (0.69 vs. 0.96 cm, p < 0.003), and Charlson comborbidity index (CCI) was higher (5.21 vs 4.96, p = 0.038). There was no significant difference in receipt of RT (65% s-MDC vs 77% standard; odds ratio [OR] = 0.55, p = 0.189), HT (78% ss-MDC vs 72% standard; OR = 1.36, p = 0.513), or both (50% s-MDC vs 59% standard; OR = 0.7, p = 0.429). The s-MDC cohort was significantly more likely to undergo accelerated (vs. standard hypofractionated) RT (70% vs 39%; OR = 3.59, p = 0.020). In s-MDC patients with completed questionnaires (n = 33), all whose selected "mostly patient (n=6)" based decision making by DAPS chose RT while all "mostly doctor (n=1)" chose no RT. Based on e-Prognosis, there were lower odds of RT for increasing Schonberg score/ higher 10 yr mortality risk (OR 0.600, p = 0.048). MMS score ≥ 40 ("maximizer") was strongly linked with the use of RT (OR 18.57, p = 0.011).
Discussion: For adults ≥65 years with early stage, ER positive breast cancer, s-MDC participation was not significantly associated with lower use of adjuvant RT or HT versus standard consultation but was significantly associated with shorter RT courses. DAPS and MMS results indicate that patient treatment preference may be predictable, highlighting an opportunity to tailor consultation discussions and recommendations based on intrinsic patient preferences and individual goals.
Competing Interests: Declaration of Competing Interest Karen Lisa Smith reports that her institution received grant funding from Pfizer; she received an honorarium from a lecture at NCCN; her husband has stock in Abbvie and ABT Labs; she is currently employed at AstraZeneca but was employed at Johns Hopkins while working on this project. Jean L. Wright has received payment as an accreditation surveyor for the American Society for Radiation Oncology (ASTRO), as the Breast section editor for the International Journal of Radiation Oncology Biology and Physics from Elsevier, and for expert witness testimony from 2020 to 2022 from Marshall Dennehy. She received support for travel and an honorarium for speaking from Physicians Education Resource for Miami Breast Cancer meeting and is Chair of Clinical Affairs and Quality Committee for ASTRO.
(Copyright © 2023 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: