Preliminary experience supporting older adults with breast cancer: Successes, challenges, and next steps for a...

Older adults diagnosed with cancer often have functional vulnerability and increased risk for treatment-related toxicity and poor outcomes, with emergent clinical strategies to mitigate these risks. The geriatric assessment (GA) is a widely recommended platform in the clinic to help inform treatment decisions and toxicity risk and initiate referrals, but incorporating the GA into busy clinical practice remains challenging.

To promote a consistent approach in conducting the GA and connecting older adults with relevant resources and services while acknowledging the specific care needs for those with breast cancer, our National Cancer Institute-designated center launched the Program for Older Adults with Breast Cancer (OABC) in May 2022, embedded within the Breast Oncology Center. The OABC coordinator offers approached patients an introduction to program services and an opportunity to undergo the GA. The coordinator uses the GA responses to facilitate appropriate geriatrics and supportive care referrals, with recommendations and utilization of services tracked in the program database. We report the initial findings from systematic GA administration within a high-volume breast cancer program.

From 2022 to 2024, 362 patients were approached to enroll in OABC; 108 completed a GA. Overall, 32.1 % were aged 70-75 and 10 % were aged ≥86, and most (2/3) had non-metastatic disease. Approximately 30 % were hospitalized in the year before enrollment, 19 % had recent falls, and the majority reported having social supports for emotional and physical needs (>65 % for each). Based on the GA (n = 108), the most frequently recommended services were geriatrics (67 %) and social work (36 %). However, only 60 % of patients who completed the GA agreed to one or more referrals to any of the recommended supportive care services.

OABC systematically reaches patients at high risk for aging-relevant needs. Coordination of services was successful, but patient declines for geriatrics and supportive resources referrals were common despite having dedicated program staff. Further efforts will increase uptake of the GA and these important services.