Frailty in Patients with Breast Cancer

Abstract

Clinical guidelines emphasize that breast cancer treatment should be based on clinical need and patient fitness, rather than age. For example, the guidelines for early breast cancer issued by the UK National Institute for Health and Care Excellence (NICE) recommends that women “irrespective of age, are offered surgery, radiotherapy and appropriate systemic therapy, unless significant comorbidity precludes it”. However, various UK-based population level studies report considerable variation in the breast cancer treatments received by older women (often defined as age 70 years or older) in comparison to younger women. The higher burden of comorbid conditions among older women may also be a significant contributing factor, with various studies showing lower rates of surgery and other therapies among women with more comorbid conditions. However, these factors only explain some of the reported variation in treatment patterns between younger and older women. One-third of all breast cancers diagnosed are in women aged 70 years or over, so addressing this variation is important for population health. The impact of ageing on health is complex and ageing can influence functional ability, physiology, and social wellbeing to different degrees. Chronological age is increasingly viewed as a poor descriptor of the ageing process. More recently, there is a much greater desire to determine 'biological age'. Geriatric associations have, for a while, recommended that a measure of frailty be used to report on ageing and its complex sequelae