Understanding long-term challenges for older breast cancer survivors

Lead author Claire Morton, MD, and senior author Christina Ahn Minami, MD, MS, both of the Department of Surgery at Brigham and Women's Hospital, published a paper in Current Breast Cancer Reports "Survivorship Issues in Older Adults with Breast Cancer. 

Q: How would you summarize your study for a lay audience?

The number of older women living with a history of breast cancer in the U.S. is growing, which is due to new diagnoses in patients over 65 and because many women diagnosed at a younger age are living longer.

Our research explores the unique challenges faced by this population, including those who were diagnosed later in life and those who have aged into survivorship. We highlight how long-term issues such as fatigue, chronic pain, mental health concerns, and physical or cognitive decline can affect quality of life well after treatment ends.

By better understanding these concerns, we aim to improve how care is planned and delivered by making it more personalized, supportive and responsive to the evolving needs of older survivors.

Q: What knowledge gap does your study help to fill?

We aimed to understand how factors, like comorbidities, persistent symptoms and age-related decline shape long-term experiences of older breast cancer survivors who were diagnosed later in life or have aged into survivorship. We also investigated how these experiences impact the quality of life of these patients.

Our goal was to identify how these challenges differ from challenges faced by younger breast cancer survivor to determine if care strategies can be better tailored to meet the needs of older patients.

Q: What methods or approach did you use?

Our team conducted a comprehensive review of existing literature, including published studies, clinical trials, and meta-analyses focused on key issues such as comorbidities, fatigue, pain, mental health, physical and cognitive decline, and frailty.

Q: What did you find?

Older adults recently diagnosed with breast cancer reported higher levels of fatigue, insomnia, transient cognitive decline, depression and anxiety compared to younger patients. While older adults are less likely to receive chemotherapy, radiation, or reconstruction, it remains unclear whether these differences are primarily driven by physician recommendations-such as concerns about treatment tolerance and comorbidities-or by patient preferences, including personal values, priorities, or fears about side effects.

We also found that women who age into survivorship, breast cancer treatment were associated with an increased risk of falls and fractures, as well as declines in frailty, functional ability, and cognitive health. Long-term survivors also frequently experience persistent fatigue and chronic pain.

Q: What are the implications?

Older adult women who are recently diagnosed with breast cancer may benefit from geriatric assessments to identify age-related conditions such as frailty and to determine where geriatric-specific support could help optimize their health before starting treatment.

Our work highlights the importance of discussing potential outcomes during cancer treatment planning to enable informed decision-making and providing continued support throughout survivorship to help reduce their impact.

Q: What are the next steps?

To continue this research, we plan to:

1. Use large, long-term datasets to more accurately identify older patients who are at high-risk for experiencing long-term symptoms and declines.
2. Continue advancing the implementation of large-scale geriatric oncology programs that incorporate geriatric assessments and personalized interventions to support older adults throughout treatment and survivorship.
3. Apply qualitative research methods to explore how best to incorporate long-term survivorship data into early treatment discussions between physicians and patients.