A ‘useful’ tool for guiding therapy
The investigators noted that chemotherapy is a complex decision for older adults with stage I-III breast cancer. While it may be indicated, chemotherapy is underused often because of the higher risk of severe toxicity in older people.
“Unfortunately, older adults aged 65 and over, who comprise about half of all breast cancer diagnoses, are significantly less likely to be offered chemotherapy compared to younger patients – sometimes because their doctors fear they won’t be able to tolerate it,” investigator Mina Sedrak, MD, of City of Hope National Medical Center in Duarte, Calif., said in a press release.
The CARG-BC score may be useful to direct therapy in older adults with early-stage breast cancer, the investigators wrote. They noted that intensifying supportive care and developing modified treatment regimens may be appropriate for patients at higher risk for toxicity.
“Although this score should not be used as the only factor in deciding whether to administer and/or alter the dose or schedule of chemotherapy, the CARG-BC score can be used to facilitate this complex decision-making process, along with clinical judgment and patient preferences,” they wrote.
“I think this is a great tool. [It] will be helpful to me to have a more accurate conversation with geriatric patients about the actual risk/benefit ratio for chemotherapy in early breast cancer,” said Amy Tiersten, MD, of Mount Sinai Hospital in New York, when asked for comment.
“If routinely implemented, it may help reduce age bias and also identify older patients who may look well but may be vulnerable and quickly decompensate while undergoing treatment,” said Lidia Schapira, MD, of Stanford (Calif.) University. “Importantly, it can be used to guide conversations about trade-offs and to start a frank conversation about an older patient’s fears and concerns about treatment.”
This research was funded by the National Institute on Aging, the Breast Cancer Research Foundation, and the Center for Cancer and Aging at City of Hope. The investigators, Dr. Schapira, and Dr. Tiersten had no relevant disclosures.