The impact of cognitive impairment on treatment allocation of elderly women with early breast cancer


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Charlene Martin1,Anne Shrestha1,Karen Collins2,Lynda Wyld1
1The University of Sheffield,2Sheffield Hallam University

Abstract

Background

Dementia affects 8% of the over 70 population. Moderate and severe dementia is associated with dependency, reduced life-expectancy, and linked to other co-morbidities. Due to impaired capacity, proxy treatment decision-making may be required. This is a key factor considered by health professionals when assessing fitness for gold standard treatment. The aim of this analysis is to show variation in treatment in early breast cancer patients with cognitive impairment.

Method

Bridging the Age Gap is a UK observational cohort study recruiting women >70 with early breast cancer. Patients that completed the Mini Mental State Examination (MMSE) were included. Cognition was defined by a pre-existing dementia diagnosis or by MMSE score of ≤21. The MMSE scores cognition as normal, mild, moderate and severe. Treatment for women with normal cognition versus dementia was compared using Pearson's Chi-squared test at 6 weeks and 6 months, post-diagnosis.

Results

1951/2960 women completed the MMSE form and 1619 had normal cognition, 276 patients, 54 patients and 2 had mild, moderate and severe dementia respectively. A further 142/2960 had a pre-existing diagnosis of severe dementia (MMSE completion not possible). Treatment was dependent on cognition category with significantly fewer women with cognitive impairment undergoing surgery at 6 weeks, (p <0.001), and 6 months, (p = 0.007) in women with ER positive tumours, for whom primary endocrine therapy was more likely to be used. The percentages of women with none, mild, moderate and severe dementia undergoing surgery were 44.4%, 6.6%, 1.1% and 2.6% respectively.

Conclusion

Cognitive impairment has a significant impact on treatment allocation in older women with early breast cancer. Patients with impaired cognition were less likely to receive gold standard treatment. The impact of this treatment allocation on breast cancer outcomes at 5 years will be the subject of a further report once the Bridging the Age Gap cohort is mature.