The Effect of Age on Health-Related Quality of Life in Patients Treated for Early Stage, Estrogen Receptor Positive Breast Cancer.

PURPOSE/OBJECTIVE(S): Prospective studies on Health-related quality of life (HRQoL) evaluating the effect of age on outcomes in breast cancer (BC) is not well studied. This study aims to examine the physical and mental health perceptions in BC patients enrolled in an international, multi-center REQUITE study.

MATERIALS/METHODS: This study includes 2,057 patients with ER+ early-stage BC treated with breast conservation surgery, radiation (RT), and endocrine therapy (ET) across Europe and North America between April 2014 and March 2017. The prospectively collected HRQoL dataset includes EORTC30 and Multidimensional Fatigue Inventory (MFI-20) at baseline, post-RT, 1, 2, and 3 years of follow up. Patients were stratified by age: 851 aged <70 (younger) and 201 aged ≥ 70 (older). The median age (range) for the younger and older cohort is 57 years (30-69 years) and 75 years (70-86 years), respectively. Analysis includes descriptive statistics and univariable logistic regression.

RESULTS: Older patients had a greater burden of comorbid conditions including increased BMI (27.3 vs 26.5; P = 0.006), history of diabetes (10.9% vs 6.6%; P = 0.0336), heart disease (15.4% vs 6.1%; P<0.0001), rheumatoid arthritis (6.5% vs 3.2%; P = 0.0280), hypertension (54.2% vs 25.0%; P<0.0001), and polypharmacy (37.8% vs 16.7%; P<0.0001) compared to younger patients. Higher utilization of aromatase inhibitor (67.7% vs 42.4%; P<0.0001) in older patients, and tamoxifen (63.7% vs 36.5%; P<0.0001) in younger patients. The T-stage distribution in younger and older patients is T1 = 82.4% vs 68.7%, T2 = 9.8% vs 26.4%, T3 = 0.1% vs 1%, respectively. The 3-year relapse-free survival was similar in both groups (P = 0.183). Significant worsening in fatigue (P<0.0001, P<0.0001), pain (P = 0.0274, P<0.0001), cognitive functioning (P = 0.0291, P<0.0001), and global health status (P = 0.0064, P<0.0001) was observed during follow up from baseline in both groups (older patients, younger patients). Compared to older patients where significant deterioration persisted, younger patients showed improvement in most HRQoL measures over the duration of follow up years. Older patients had poorer global health status (OR = 1.19 vs 0.8, P = 0.0214) than younger patients from baseline at 2 years. On the MFI-20 measure, both age groups showed worsening fatigue from baseline at post-RT, but eventual recovery noted in the 1-to-3-year follow up period.

CONCLUSION: Older patients, present with greater comorbidities, polypharmacy, and later stages in BC, reported worsening fatigue, pain, cognitive functioning, and global health status during 3 years follow up. One limitation of this study is that patients were predominately White, potentially limiting the generalizability of these observations. Further studies supplementing biomarkers and prognostic signatures with functional measures such as HRQoL may provide a useful tool to guide risk-tailored treatment in older patients with breast cancer.