Understanding the survivorship experience of older breast cancer patients

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.

Research appearing in Current Breast Cancer Reports explores the unique challenges faced by this population, including those who were diagnosed later in life and those who have aged into survivorship. The paper is titled “Survivorship Issues in Older Adults with Breast Cancer.”

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, 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, they aim to improve how care is planned and delivered by making it more personalized, supportive and responsive to the evolving needs of older survivors.

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

The 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.

The 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.

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.

The team found that in women who aged into survivorship, breast cancer treatment was 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.

Older adult women who have recently been 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.

The researchers say their 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.

To continue this research, the team plans 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.