Current Oncology (Dec 2021)

Management Strategies for Older Patients with Low-Risk Early-Stage Breast Cancer: A Physician Survey

  • Mashari Alzahrani,
  • Mark Clemons,
  • Lynn Chang,
  • Lisa Vendermeer,
  • Angel Arnaout,
  • Gail Larocque,
  • Katherine Cole,
  • Tina Hsu,
  • Deanna Saunders,
  • Marie-France Savard

DOI
https://doi.org/10.3390/curroncol29010001
Journal volume & issue
Vol. 29, no. 1
pp. 1 – 13

Abstract

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When managing older patients with lower-risk hormone-receptor-positive (HR+), HER2 negative (HER2−) early-stage breast cancer (EBC), the harms and benefits of adjuvant therapies should be taken into consideration. A survey was conducted among Canadian oncologists on the definitions of “low risk” and “older”, practice patterns, and future trial designs. We contacted 254 physicians and 21% completed the survey (50/242). Most respondents (68%, 34/50) agreed with the definition of “low risk” HR+/HER2− EBC being node-negative and either: ≤3 cm and low histological grade, ≤2 cm and intermediate grade, or ≤1 cm and high grade. The most popular chronological and biological age definition for older patients was ≥70 (45%, 22/49; 45% 21/47). In patients ≥ 70 with low risk EBC, most radiation and medical oncologists would recommend post-lumpectomy radiotherapy (RT) and endocrine therapy (ET). Seventy-eight percent (38/49) felt that trials are needed to evaluate RT and ET’s role in patients ≥ 70. The favored design was ET alone, vs. RT plus ET (39%, 15/38). The preferred primary and secondary endpoints were disease-free survival and quality of life, respectively. Although oncologists recommended both RT and ET, there is interest in performing de-escalation trials in patients ≥ 70.

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