Frailty Predicts Noninitiation but Not Discontinuation of Adjuvant Hormonal Therapy in Older Women With Breast Cancer
In a study reported in the Journal of Clinical Oncology, Sheppard et al found that frailty was a significant predictor of not starting adjuvant hormonal therapy in breast cancer patients aged ≥ 65 years, but was not predictive of discontinuation of treatment.
Study Details
The study was performed in a prospective cohort (Cancer and Leukemia Group B [CALGB] 369901) of 1,288 women aged ≥ 65 years diagnosed with invasive nonmetastatic breast cancer recruited from 78 sites between 2004 and 2011. Of these, 1,062 had estrogen receptor–positive tumors.
Interviews were conducted at baseline, 6 months, and every year up to 7 years. Initiation of hormone therapy was identified from records and discontinuation was identified by self-report. Baseline frailty was measured using a validated 35-item scale, with patients being characterized as prefrail, frail, or robust.
Among the 1,062 patients with estrogen receptor–positive disease, mean age was 73 years, and 76% were considered robust, 19% prefrail, and 5% frail. Hormonal therapy was not initiated in 14%.
Noninitiation
On multivariate analysis including factors found to be significant on univariate analysis (age, race, marital status, Medicare Part D or insurance coverage, frailty status) and disease stage, the odds of noninitiation of hormone therapy were significantly higher for prefrail/frail vs robust patients (odds ratio [OR] = 1.63, P = .013). Increasing age (OR = 1.03, P = .029, as continuous variable) and nonwhite vs white race (OR = 1.71, P =.033) were also significant predictors of noninitiation.
Median follow-up time from initiation was 3 years. The continuation rate at 5 years was 48.5% and was lower in the prefrail/frail group than the robust group (41% vs 50%, P = .045). On multivariate analysis including factors found to be significant on univariate analysis (age, marital status, home ownership, disease stage, chemotherapy or no chemotherapy, frailty status, knowledge of patient, thoroughness of care, trust in physician, optimism, ageism, emotional support, and tangible support), only greater age (hazard ratio [HR] = 1.03, P = .005) and stage ≥ IIB vs I disease (HR = 0.57, P = .003) were significant predictors of discontinuation.
The investigators concluded, “Frailty is associated with noninitiation of hormonal therapy, but it does not seem to be a major predictor of early discontinuation in older patients.”
Vanessa B. Sheppard, PhD, of Georgetown University, Lombardi Comprehensive Cancer Center, is the corresponding author for the Journal of Clinical Oncology article.
The study was supported by grants from the National Cancer Institute and by Amgen Pharmaceuticals. For full disclosures of the study authors, visit jco.ascopubs.org.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
