An update in breast cancer management for elderly patients

Domenico Fusco, Elena Allocca, Emanuele Rocco Villani, Laura Franza, Alice Laudisio, Giuseppe Colloca


Breast cancer in commonly diagnosed in older women. Older women are underrepresented in clinical trials and evidence on the best treatment are insufficient. Ageing is associated with increased number of comorbidities, polypharmacy, geriatric syndromes, as well as with progressive loss of resilience to stressors, a phenomenon known as frailty. The large variety in characteristics within this population, together with the lack of evidence on the most suitable therapeutic approach and the limited data on older patients’ preferences, make treatment decision-making for these patients generally difficult Frail or pre-frail older adults have a high risk of experiencing adverse effects and complications from surgery, radiotherapy and systemic therapies (either chemotherapy, biological or hormonal therapies). At present comprehensive geriatric assessment represent the best instrument to assess biological age and to assist surgeons, medical oncologists and radiotherapists in defining a personalized approach to the care of older women with breast cancer. According to guidelines we propose the use of a screening tools (such as G8) to identify those patients which are frail or pre-frail and that should undergo more comprehensive assessment as well as specific interventions. Health related quality of life and patient reported outcomes are discussed as relevant issues in the care of older women with breast cancer.