New Tool Helps Seniors with Breast Cancer Make Chemotherapy Decisions

Jan. 14, 2021
doctors speaks with elderly cancer patient
Oncologist Allison Magnuson talks to breast cancer patient Nancy Simpson. (Photo credit: Adrian Kraus/AP) (Note: Photo taken prior to the COVID-19 pandemic.)

A new tool, developed in part by the Wilmot Cancer Institute, can predict which older women with early-stage breast cancer are more likely to experience severe chemotherapy side effects and which ones are not.

Researchers developed and validated the tool by studying a group of 473 older adults with early-stage breast cancer who were receiving chemotherapy. The tool stratifies patients into low, intermediate or high-risk pools. It provides useful information for oncologists to anticipate the potential for chemotherapy side effects, dose delays, and hospitalizations.

“This new tool fills a critical knowledge gap and will make complex decisions about chemotherapy more informed,” said Allison Magnuson, D.O., M.S., the Wilmot geriatric oncologist who led the Rochester team in this national effort to develop and validate the scoring system for seniors.

Researchers uncovered eight key predictors of severe toxicities, including anemia, poor liver function, limited mobility and falls, and lack of social support such as having someone to call in a crisis. Limited support may influence whether a person offers timely information to the health care team about difficulty with chemotherapy. The predictors allowed the team to score risks and successfully assign patients to risk groups.

Magnuson is lead author of a publication in the Journal of Clinical Oncology, detailing the design and benefits of the new risk tool.

It was badly needed: Most risk assessments for chemotherapy and other cancer treatments have been evaluated in younger people, even though nearly half of all individuals diagnosed with breast cancer are 65 or older.

Anemia, fever, fatigue, dehydration, infection, and neutropenia (low white blood counts) are among the most common chemotherapy side effects — and those toxicities can impact seniors differently, depending upon their health status and level of social and family support.

The study included cancer patients with a mean age of 70 at 16 institutions across the U.S.; many were enrolled as clinical study participants at Wilmot. Of the 473 women, nearly 49 percent developed moderate or serious chemotherapy side effects. About a quarter of the patients had an unplanned dose reduction and another quarter had a dose delay, and 23 percent had to be hospitalized during treatment.

“Not only is this study useful for clinicians, but as we further look for ways to integrate geriatric oncology principles into routine oncology practice, it can provide researchers with new ideas for designing clinical trials that are relevant to older cancer patients to help support them through cancer treatment,” Magnuson said.

Wilmot geriatric oncologists are leaders in the field of assessing the physical and social/emotional fitness of seniors who face cancer, to help them decide what treatment regimens are most suitable based on their personal situations.

Funded by the National Institute on Aging and the Breast Cancer Research Foundation, the study began under the leadership of Arti Hurria, M.D., who died tragically in a traffic accident in 2018. She was a mentor to Magnuson and the well-regarded Director of the Center for Cancer and Aging at City of Hope near Los Angeles. Magnuson presented the findings at the annual San Antonio Breast Cancer Conference and led publication of the primary study results.