Thesis

Age differences in the factors affecting baseline assessment and systemic treatment allocation for breast cancer females in Kuwait

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Awarding institution
  • University of Strathclyde
Date of award
  • 2022
Thesis identifier
  • T16365
Person Identifier (Local)
  • 201654788
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Department, School or Faculty
Abstract
  • Introduction: Breast cancer is the most common cancer occurring in females, and it accounts for 25.1% of all cancers. Worldwide statistics highlight that around 40% of breast cancer cases occur in patients aged 65 years and above, with expectations that this will increase as the population gets older. Cancer management in older patients is still unclear and depends primarily on individual oncologist decisions. The literature suggests that older breast cancer patients receive less intensive chemotherapy compared to younger patients, which is mainly attributed to a lack of effective individualized assessment. The current study investigated and compared the differences in the factors affecting baseline assessments and systemic treatment allocation and outcomes between younger and older breast cancer patients in Kuwait. Methods: In a comparative prospective population-based observational cohort study, a total of 180 patients with breast cancer were included and subdivided into two age categories (<60 or ≥60 years). Data were collected manually from the breast cancer new-case clinics at the Kuwait Cancer Control Center (KCCC) between April 2016 and April 2019. The correlation between baseline factors (age, performance status, comorbidities, polypharmacy, BMI, and disease stage) and treatment allocation (intensive versus less intensive protocols) was investigated using multivariate logistic regression analysis. Factors contributing to less intensive treatment were identified and compared between the two age cohorts. Results: A higher prevalence of less intensive treatment allocation was observed in patients aged ≥60 years than younger patients [41.2% vs 4.9%, OR 0.16 (CI 0.049-0.52), p-value 0.001]. Unlike younger patients, older patients with PS=0 and two comorbidities were 83% and 50% less likely to receive intensive treatment. The correlation between the co-existence of diabetes and hypertension and intensive treatment allocation was negatively affected by age due to the risk of cardiotoxicity. However, older and younger patients having ≥3 comorbidities were 86% less likely to receive intensive treatment. Besides, patient interference with the treatment plan occurred in 15% and 0.3% of older and younger patients. Overall, significantly increased neurotoxicity was observed among older patients than younger patients (33.3% and 19.2%), and increased nausea was observed among younger patients than older patients (56.7% and 38.3%). Intensive treatment toxicities and subsequent dose modifications were comparable between older and younger patients. In subgroup analyses of the older age cohort, intensive treatment contributed to increased nausea (57% vs 12%), vomiting (11% vs 0%), and mucositis (26% vs 8%) than less intensive treatment, while less intensive treatment contributed to increased depression (28% vs 6%). Cardiotoxicity, defined as ≥10% decline in the left ventricular ejection fraction (LVEF), occurred in 86.7% and 55.6% of older and younger patients. Factors contributing to increased cardiotoxicity were an age of ≥60 years [OR 4 (CI 1.35-18.6), p-value 0.012] and baseline LVEF ˂60 [OR 2.1, CI (0.73-7.99), p-value 0.15]. Conclusion: An age of 60 years and above was associated with a higher prevalence of less intensive treatment allocation compared to younger age among breast cancer patients in Kuwait. Factors contributing to less intensive treatment allocation included increased comorbidity burden, advanced performance status, and risk of treatment-induced cardiotoxicity. The lack of effective standardized baseline assessments contributed to differences in the factors correlated with less intensive treatment by age cohort due to toxicity concerns.
Advisor / supervisor
  • Mullen, Alexander
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DOI

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