Addressing frailty in patients with breast cancer: A review of the literature

Various studies have documented variation in the management of older patients with breast cancer, and some of this variation stems from different approaches to balancing the expected benefit of different treatments, with the ability of patients to tolerate them. Frailty is an emerging concept that c...

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Bibliographic Details
Published in:European journal of surgical oncology 2020-01, Vol.46 (1), p.24-32
Main Authors: Jauhari, Yasmin, Gannon, Melissa Ruth, Dodwell, David, Horgan, Kieran, Tsang, Carmen, Clements, Karen, Medina, Jibby, Tang, Sarah, Pettengell, Ruth, Cromwell, David Alan
Format: Article
Language:English
Subjects:
Age Factors
Aged
Breast cancer
Breast Neoplasms - therapy
Elderly
Female
Frail Elderly
Frailty
Frailty - diagnosis
Geriatric Assessment
Humans
Middle Aged
Patient Care Planning
Review
Risk Factors
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Summary:Various studies have documented variation in the management of older patients with breast cancer, and some of this variation stems from different approaches to balancing the expected benefit of different treatments, with the ability of patients to tolerate them. Frailty is an emerging concept that can help to make clinical decisions for older patients more consistent, not least by providing a measure of ‘biological’ ageing. This would reduce reliance on ‘chronological’ age, which is not a reliable guide for decisions on the appropriate breast cancer care for older patients. This article examines the potential of frailty assessment to inform on breast cancer treatments. Overall, the current evidence highlights various benefits from implementing comprehensive geriatric assessment and screening for frailty in breast cancer patients. This includes a role in supporting the selection of appropriate therapies and improving physical fitness prior to treatment. However, there are challenges in implementing routine frailty assessments in a breast cancer service. Studies have used a diverse array of frailty assessment instruments, which hampers the generalisability of research findings. Consequently, a number of issues need to be addressed to clearly establish the optimal timing of frailty assessment and the role of geriatric medicine specialists in the breast cancer care pathway.
ISSN:0748-7983
1532-2157
DOI:10.1016/j.ejso.2019.08.011