Adherence to multidisciplinary team meeting recommendations in elderly patients with HER2-positive breast cancer

Abstract

Abstract Purpose Applying current treatment guidelines to elderly breast cancer (BC) patients is challenged by limited trial guidance, higher toxicities, and non-cancer related mortality. This study investigated adherence to multidisciplinary team meeting (MDTM) recommendations in elderly women with HER2 positive BC (HER2+BC) and its impacts on patient survival. Methods This retrospective multicentre cohort study collected data from 305 patients with primary diagnosis of HER2+BC. Women aged ≥65 years were classified into “concordant” or “discordant” groups according to MDTM recommendation adherence. Cox proportional hazards models and logistic regression analysis were used to assess the association between prognostic factors and patient outcomes. Results Of 305 HER2+BC patients, 111 (36%) were ≥65 years old. Of these, 55 (49.5%) and 53 (47.7%) were assigned to the concordant or discordant groups, respectively. The most frequent cause of MDTM discordance was treatment rejection by patients (57%). Median age (79 vs 70 years, p = <0.001) and Charlson Comorbidity Index (score 6 vs 5, p = 0.017) were significantly higher in the discordant group. After adjusting for age, UICC stage and hormone receptor status, overall survival (OS; HR 1.49, CI [0.64-3.46], p = 0.36) showed no significant difference between groups with a median follow up of 42.8 months. Patients with pre-existing cardiac diseases (29.6%) had significantly reduced OS (log-rank test p = 0.0082). Conclusion Adjustments to MDTMs for older BC patients may be necessary to increase patient treatment acceptance. Moreover, approaches to reduce treatment intensity in selected elderly patients with HER2+BC should be investigated further.