There are numerous reports of suboptimal care in the UK for older patients with breast cancer. This is thought to account for a substantial portion of the gap in survival for patients with breast cancer in the UK compared to other developed countries.
NABCOP data suggests that around 90% of patients aged 70+ with ER+ EIBC are likely to be fit enough to undergo initial surgery (approximately 90% of ER-older patients have surgery). Significant (>2 SD) differences from a 80% use of initial surgery in a Breast Unit in this population of patients aged 70+ with ER+ EIBC would be of concern.
There will be instances when diminished patient cognition, medical fitness or the presence of frailty or limited life expectancy, suggest surgery is not the preferred pathway. PET may be appropriate in these circumstances in full transparent discussion with the patient and their family and carers. Deferred surgery following a defined period of PET for a specific reason such as tumour downstaging, medical optimisation which is protocol based or involvement in approved clinical trials is reasonable but the use of PET for fit patients or those with relatively minor co-morbidity outside these circumstances is discouraged.
The NABCOP project team has devised a simple, pragmatic single A4 sheet assessment aid for completion at their initial diagnostic clinic visit in all patients over 70 years, which would further inform the patient discussion at the Diagnostic MDT.
The individual component parts of the form are mandatory, returnable data items on every Trust's COSD returns from 1st April 2020.