Li Keva, Chadha Manjeet, Moshier Erin, Rosenstein Barry S
Icahn School of Medicine at Mount Sinai, Department of Medicine, New York, NY 10029, United States of America.
Icahn School of Medicine at Mount Sinai, Department of Radiation Oncology, New York, NY 10029, United States of America.
J Geriatr Oncol. 2025 Mar;16(2):102195. doi: 10.1016/j.jgo.2025.102195. Epub 2025 Feb 6.
Health-related quality of life (HRQoL) in older patients with breast cancer (BC) (≥70 years) is not well studied. This study assesses aging-related differences in patient-reported outcomes among estrogen receptor-positive (ER+) patients with BC treated with breast conservation surgery (BCS), radiation therapy (RT), and endocrine therapy (ET).
Among the 2,057 patients with ER+ early-stage BC enrolled in the prospective multicenter REQUITE study, 1,003 patients receiving adjuvant RT + ET as the only systemic therapy constitute our study population. Patients were stratified by age into younger (<70 years, n = 810 patients) and older (≥70 years, n = 193 patients) groups. Prospectively collected HRQoL was measured using the validated European Organization for Research and Treatment of Cancer (EORTC) quality of life of cancer patients (QLQ-30) and breast cancer-specific quality of life (QLQ-BR23), and Multidimensional Fatigue Inventory (MFI-20) measures at baseline following BCS and pre-adjuvant treatment, post-RT, and at one-year, two-year, and three-year intervals. Statistical analysis involved a mixed model analysis of variance, weighted by propensity scoring.
Older patients had a higher burden of comorbidities, larger tumor size, and higher rates of N1 disease compared to the younger group. RT boost to the lumpectomy site was more often delivered in younger participants (72 %) compared to older (50 %). Younger patients predominately received tamoxifen (63.5 %), while older patients more commonly received aromatase inhibitors (67.4 %). Throughout the follow-up, we observed that the younger patients showed greater recovery in QoL domains including sexual enjoyment, systemic side effects, breast symptoms, global health status, and emotional, physical, and social functioning compared to the older group. Cognitive function, which declined from baseline in both groups, improved over time in younger participants but persisted at lower levels in older patients at the three-year follow-up period.
Adjuvant treatments differentially impacted HRQoL, with older patients experiencing greater and more persistent adverse effects compared to younger counterparts. These findings underscore the need for tailored interventions that address the unique challenges in HRQoL recovery among older BC survivors.
老年乳腺癌（BC）患者（≥70岁）的健康相关生活质量（HRQoL）尚未得到充分研究。本研究评估了接受保乳手术（BCS）、放射治疗（RT）和内分泌治疗（ET）的雌激素受体阳性（ER+）BC患者中与衰老相关的患者报告结局差异。
在前瞻性多中心REQUITE研究纳入的2057例ER+早期BC患者中，1003例接受辅助RT+ET作为唯一全身治疗的患者构成我们的研究人群。患者按年龄分层为较年轻组（<70岁，n = 810例患者）和老年组（≥70岁，n = 193例患者）。前瞻性收集的HRQoL使用经过验证的欧洲癌症研究与治疗组织（EORTC）癌症患者生活质量量表（QLQ - 30）、乳腺癌特异性生活质量量表（QLQ - BR23）以及多维疲劳量表（MFI - 20）在BCS后的基线、辅助治疗前、放疗后以及1年、2年和3年随访时进行测量。统计分析采用倾向评分加权的混合模型方差分析。
与较年轻组相比，老年患者合并症负担更高、肿瘤更大且N1期疾病发生率更高。与老年患者（50%）相比，较年轻参与者（72%）更常接受瘤床加量放疗。较年轻患者主要接受他莫昔芬（63.5%），而老年患者更常接受芳香化酶抑制剂（67.4%）。在整个随访过程中，我们观察到与老年组相比，较年轻患者在包括性享受、全身副作用、乳腺症状、总体健康状况以及情感、身体和社会功能等生活质量领域恢复得更好。两组患者的认知功能均从基线下降，但在较年轻参与者中随时间有所改善，而在3年随访期老年患者中仍维持在较低水平。
辅助治疗对HRQoL的影响存在差异，老年患者比年轻患者经历更严重且更持久的不良反应。这些发现强调了需要采取针对性干预措施，以应对老年BC幸存者在HRQoL恢复方面的独特挑战。
