Li Keva, Moshier Erin, Shao Theresa, Rosenstein Barry S, Chadha Manjeet
Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Ann Surg Oncol. 2025 Apr 26. doi: 10.1245/s10434-024-16482-4.
There is limited data on health-related quality of life (HRQoL) in older breast cancer (BC) patients. This study examines patient-reported outcomes (PROs) by type of endocrine therapy (ET) prescribed, aromatase inhibitors (AI), or tamoxifen (Tam) to estrogen receptor-positive BC patients aged ≥70 years.
This retrospective review includes 1052 women diagnosed with early-stage BC from the REQUITE study database, who underwent breast conservation surgery (BCS), and received adjuvant breast radiation therapy (RT), and ET as the only systemic therapy. Among them, 201 women were aged ≥70 years. The PROs were assessed by using EORTC-QLQ-C30, BR23, and Multidimensional Fatigue Inventory measures obtained at baseline after BCS, post-RT, and at 1, 2, and 3 years follow-up. Statistical analysis involves mixed model analysis of variance and propensity score weights.
Among the 201 women, 131 received AI, and 70 received Tam. The overall mean age of this cohort is 75.3 years. Compared with Tam, AI-treated patients experience worse insomnia and general and physical fatigue. Tam-treated patients experienced more physical and cognitive functioning decline than the AI-treated patients. The Tam-treated patients also reported more mental fatigue and reduced sexual enjoyment compared to the AI-treated patients.
This study suggests a differential impact by type of ET on distinct HRQoL domains experienced by older postmenopausal women. Furthermore, larger prospective clinical trials are necessary to inform treatment decisions for older ER-positive BC patients, considering patient preferences and understanding trade-offs between disease outcomes and HRQoL.
关于老年乳腺癌（BC）患者健康相关生活质量（HRQoL）的数据有限。本研究通过对≥70岁的雌激素受体阳性BC患者所开具的内分泌治疗（ET）类型（芳香化酶抑制剂[AI]或他莫昔芬[Tam]）来检查患者报告结局（PROs）。
这项回顾性研究纳入了来自REQUITE研究数据库的1052名被诊断为早期BC的女性，她们接受了保乳手术（BCS），并接受了辅助性乳腺放疗（RT），且ET作为唯一的全身治疗。其中，201名女性年龄≥70岁。通过使用在BCS后基线、放疗后以及1年、2年和3年随访时获得的欧洲癌症研究与治疗组织生活质量核心问卷（EORTC-QLQ-C30）、BR23和多维疲劳量表来评估PROs。统计分析包括方差混合模型分析和倾向得分加权。
在这201名女性中，131名接受了AI，70名接受了Tam。该队列的总体平均年龄为75.3岁。与Tam相比，接受AI治疗的患者失眠、总体和身体疲劳情况更差。接受Tam治疗的患者比接受AI治疗的患者身体和认知功能下降更多。与接受AI治疗的患者相比，接受Tam治疗的患者还报告有更多的精神疲劳和性快感降低。
本研究表明ET类型对老年绝经后女性所经历的不同HRQoL领域有不同影响。此外，考虑到患者偏好以及理解疾病结局与HRQoL之间的权衡，有必要进行更大规模的前瞻性临床试验，为老年ER阳性BC患者的治疗决策提供依据。
