{"paper_id":"0ee9396b-0b28-4d77-a86b-9fd1d75f4559","body_text":"Association of comprehensive geriatric assessment with multidisciplinary treatment decision and adherence in elderly breast cancer patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Association of comprehensive geriatric assessment with multidisciplinary treatment decision and adherence in elderly breast cancer patients Yihua Jin, Jing Yu, Xu Zhang, Siji Zhu, Kunwei Shen, Xiaosong Chen This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4201532/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose To assess the association of comprehensive geriatric assessments (CGA) and multidisciplinary team (MDT) treatment decision and adherence in elderly breast cancer patients. Methods Aged ≥ 60 patients were prospectively enrolled between June 2019 and January 2020. CGA was surveyed by 9 questionnaires before breast cancer surgery. Adjuvant treatment decisions were made by MDT discussion. Factors associated with adjuvant treatment decision were analyzed. Patients’ adherence to MDT decision according to CGA were also analyzed. Results A total of 211 patients were included: 87 (41.2%), 102 (48.3%), and 22 (10.4%) patients with age between 60–69, 70–79, and over 80, respectively. Patients with lower scores of VES-13 (95.7% vs 77.8%, P = 0.021) and higher scores of BI (96.7% vs 75%, P = 0.003) were more likely to be recommended with adjuvant radiotherapy. Rates of adjuvant chemotherapy recommendation was also higher for patients with lower VES score (46.8% vs 21.1%, P = 0.004) and higher BI score (45.6% vs 27.5%, P = 0.037). Adherence to adjuvant chemotherapy recommendation was found better in patients with fitter scores of CCI-adjustment (80.3% vs 53.8%, P = 0.038) Conclusion CGA was associated with adjuvant radiotherapy MDT decision, which also influenced the adherence to MDT adjuvant chemotherapy recommendation in elderly breast cancer patients. Older Patients Breast cancer Comprehensive geriatric assessments Multidisciplinary treatment Adjuvant therapy Adherence Figures Figure 1 Figure 2 Figure 3 1. Introduction Breast cancer has been the leading diagnosed cancer in female since 1975, and it is estimated that there will be 297,790 new cases, and 43,170 deaths in 2023 [ 1 ]. Mortality rates of breast cancer continues to increase with age [ 2 ]. Considering the complexity of cancer care, multidisciplinary team (MDT) strategy is widely used to improve coordination, communication, and decision making between health-care team members and patients[ 3 ]. In a randomized clinical trial, adding an MDT discussion before chemotherapy initiation reduced the incidence rate of high-grade chemotherapy-related toxicity effects in elderly breast cancer patients[ 4 ]. Moreover, locally advanced breast cancer patients also benefit from MDT with better local control and fewer relapses[ 5 ]. A retrospective trial conducted in our center reported that compliance with MDT recommendations was closely related to overall survival (OS) and disease-free survival (DFS)[ 6 ]. However, older breast cancer patients tended to have poor compliance[ 6 , 7 ]. Older patients are a highly heterogenous group, characterizing with many age-related conditions[ 8 ]. On the one hand, senescence remodels the tumor microenvironment, thus influencing the therapy response[ 9 ]. On the other hand, problems such as cognitive impairment, reduced mobility, polypharmacy, multimorbidity come along with aging [ 10 ]. Comorbidities were closely associated with lower compliance[ 11 ]. Moreover, researches in growing numbers focus on undertreatment and overtreatment due to heterogeneity in geriatric oncological patients[ 12 ]. As life expectancy increases, the contraindication has been sharpening between the estimated surging numbers of geriatric breast cancer patients and the persisting scarcity of data from clinical trials for this population[ 13 ]. Comprehensive geriatric assessment (CGA), as a pivotal tool to uncover vulnerabilities and needs of elderly patients, might be beneficial in the design of personalized interventions and improvement of prognosis[ 14 ]. The importance of integrating CGA into oncology clinical care has been reiterated by the American Society of Clinical Oncology (ASCO), the International Society of Geriatric Oncology (SIOG), and the European Society of Breast Cancer Specialists (EUSOMA)[ 8 , 15 ]. CGA, as a comprehensive and multidomain assessment (i.e., minimum functional status, mobility, nutritional status, mood, cognition, and comorbidities), has shown diverse benefits, including mortality prediction, treatment plan individualization, patient-related outcomes (PROs) emphasis, and possible cost-effectiveness[ 16 ]. However, only few percentages of oncologist used CGA into clinical practice, probably owing to lack of knowledge or training[ 17 ]. Therefore, there is still an urgent need for more researches to demonstrate the necessity of CGA. In current study, we aimed to prospectively evaluate the CGA status of elderly breast cancer patients, thus to analyze whether different CGA status would influence the decision-making as well as compliance with MDT. 2. Methods 2.1 Data processing Patients were prospectively recruited between June 2019 and January 2020 from Shanghai Ruijin Hospital. Eligibility were as follows: patients aged over 60 years; received curative surgery of breast cancer after recruitment; attended the MDT discussion. Patients were excluded from the study if they refused biopsy for pathological diagnosis, being diagnosed with benign lesion, chose non-surgical treatment, or received curative surgery before CGA survey. Clinicopathological characteristics including medical history of cancer, family history of breast cancer, pathologic type, histologic grade, tumor size, lymph node involvement, and expression of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) and Ki-67 were extracted from the Shanghai Jiao Tong University Breast Cancer Database. The cut-off point for ER and PR expression was set at 1%. Meanwhile, tumors were considered as HER2-positive only if scored 3 + by immunohistochemistry (IHC) or 2 + by IHC and amplified by fluorescence in situ hybridization (FISH).Meanwhile, treatment details including type of surgery, MDT advice adjuvant treatment received, as well as the follow-up information were also retrieved. 2.2 CGA assessment Each participant was asked to complete a panel of geriatric assessment tools through a smartphone app, which include: Vulnerable Elders Survey (VES-13)[ 18 ], Barthel Index (BI)[ 19 ], Eastern Cooperative Oncology Group Performance Status (ECOG PS)[ 20 ], Activities of Daily Living (ADL)[ 21 ], Instrumental Activities of Daily Living (IADL)[ 21 ], 6-Item Cognitive Impairment Test (6-CIT)[ 22 ], Charlson's Comorbidity Index (CCI)[ 23 ], and American Society of Anesthesiologists Score (ASA Score)[ 24 ]. Above scales were attached in the supplementary materials. Except for the one in 6-CIT, the thresholds for determination of fitness according to questionnaires were mainly based on population distribution by setting a cutoff value closest to the median. For 6-CIT, suggested stratifications for this questionnaire were used, that is normal if scoring 0–7, moderate cognitive impairment if scoring 8–9, and obvious cognitive impairment if scoring 10–28. To avoid the bias caused by age, CCI-adjustment was used when the score of age was removed from the final score of CCI. 2.3 MDT Discussion An MDT discussion is held routinely to formulate individualized adjuvant treatment recommendations for patients with early breast cancer who have undergone surgery as soon as the complete pathological report was achieved. Physicians from various disciplines constitute a panelist, including breast surgeons, medical oncologists, pathologists, radiation oncologists, and breast specialized nurses. A complete treatment recommendation is offered to patient after the MDT discussion, including radiotherapy (yes or no), chemotherapy (yes or no, drugs and cycles), endocrine therapy (yes or no, selective estrogen receptor modulator (SERM) or aromatase inhibitor (AI), with or without ovarian function suppression (OFS)), and HER2 target therapy (yes or no, trastuzumab alone or with pertuzumab). Radiotherapy was only discussed among patients with T3 tumors, positive lymph node metastasis, or patients receiving breast conserving surgery. Chemotherapy was discussed among all patients. Endocrine therapy was only discussed among patients with hormone receptor (HR) positive tumors, and target therapy was discussed among patients with HER2 positive breast cancer. 2.4 Measurement of non-adherence Treatment adherence was evaluated in all patients according to whether their actual treatment was the same as the one suggested by MDT discussion, which was evaluated by the physicians during outpatient service, or assessed by specialist nurse via phone calls. Non-adherence was defined in the following circumstances: (1) the patient refused to accept the prescribed regimen recommended by MDT discussion, (2) the patient chose a treatment plan different from the recommended one (using a different drug or different dose), (3) the patient failed to complete the whole recommended treatment plan. The adherence was investigated in each of the treatment patterns, including: radiotherapy, chemotherapy, endocrine therapy, and target therapy. The adherence was assessed only in patients who were suggested to receive the corresponding adjuvant therapy. The overall adherence was identified if the actual therapy was the same as the one recommended by MDT discussion in all the four treatments patterns. Otherwise, the overall non-adherence will be recognized. 2.5 Statistical considerations Clinicopathological characteristics were presented as patient number and percentage [n, (%)]. Results of CGA were presented as categorial variables. Distribution of the geriatric assessment among different age groups as well as patients’ adherence according to CGA results were calculated by Fisher’s exact test. Two-side P-value of < 0.05 was considered statistically significant. Analysis was conducted using SPSS version 26 (SPSS Inc., Chicago, IL, USA) for Mac and the figure was created using GraphPad Prism 9 (GraphPad Prism, Inc., San Diego, CA, USA). 3. Results 3.1 Basic characteristics Overall, there were 273 patients completed the CGA survey. Among whom, 215 patients underwent a breast cancer surgery and 211 patients attended the MDT after surgery (Fig. 1 ). Among these 211 patients, there were 207 females and 4 males. The median age was 71 years (range, 63–90). A total of 25 patients had a breast-related medical history and 3 of them have had breast cancer. History of malignancy was present in 9 patients and family history of breast cancer was present in 17 ones. There were 87 (41.2%), 102 (48.3%), and 22 (10.4%) patients categorized in the age group of 60–69 years, 70–79 years and above 80 years, respectively. Other patient and tumor detailed characteristics are listed in Table S1 . Invasive ductal carcinoma (IDC) was the most common pathologic type with 117(55.5%) patients in all age groups. There were 96(45.5%) patients had grade II disease. Tumors no more than 2.0cm were present in 126 (59.7%) patients. Lymph node metastasis was seen in 94 (44.5%) patients. There were 170 (80.6%) patients had an ER positive disease and 155 (73.5%) patients had a PR positive disease, while patients with a HER2 positive disease were only 19 (9.0%). High expression of Ki-67 (≥ 14%) was seen in 117(55.5%) patients. There was no significant difference of clinicopathological characteristics among three age groups. 3.2 CGA parameters scores according to age Scores of certain geriatric assessments were significantly different among age groups, including VES-13, BI, ADL, IADL and 6-CIT. Regarding VES-13, older patients were more likely to have a higher score that represented unhealthy conditions (5.7% vs. 18.6% vs. 63.6% in age group of 60–69 years, 70–79 years, and above 80 years respectively, P < 0.001, Table S2). When using Barthel Index, older patients were more likely to have a lower score that represented unhealthy conditions (10.3% vs. 17.6% vs. 59.1% in age group of 60–69 years, 70–79 years, and above 80 years respectively, P < 0.001, Table S2). The results of ADL demonstrated that older patients tended to have difficulties in daily activities (18.4% vs. 28.4% vs. 68.2% in age group of 60–69 years, 70–79 years and above 80 years respectively, P < 0.001, Table S2). The similar conclusion was also drawn when using IADL. Furthermore, there was a concentrated distribution of older patients in high-score groups regarding 6-CIT (11.5% vs. 17.6% vs. 31.8% in age group of 60–69 years, 70–79 years, and above 80 years respectively, P = 0.045, Table S2), indicating older patients were more likely to have a score that represented unhealthy conditions. 3.3 Surgery choices according to age and CGA Among 211 eligible patients, there were 150 (71.1%) and 61 (28.9%) patients receive mastectomy and breast conserving surgery, respectively. Overall, 29.9% (26 out of 87), 25.5% (26 out of 102), and 40.9% (9 out of 22) had breast conserving surgery in 60–69 years, 70–79 years, and over 80 years age groups, respectively ( P = 0.339). Axillary surgery was performed on 94.3% (199/211) of all patients, among whom, 149 (74.9%) underwent sentinel lymph node biopsy (SLNB) and 137 (68.8%) had axillary lymph node dissection (ALND). When grouped by age, 63 out of 87 patients aged 60–69 (72.4%), 73 out of 102 patients aged 70–79 (71.6%), and 13 out of 22 patients aged over 80 years (59.1%) received SLNB, respectively ( P = 0.452). Moreover, 55 out of 87 patients aged 60–69 (63.2%), 70 out of 102 patients aged 70–79 (68.6%), and 12 out of 22 patients aged over 80 years (54.5%) received ALND, respectively ( P = 0.414). There was no statistically significant difference in the choice of breast surgery among different groups of CGA scores. However, the choice of lymph node surgery was differently distributed according to the scores of ADL, IADL, and ASA Score. Regarding ADL, there was a higher tendency for patients with higher score to receive lymph node surgery (95.6% vs. 86.2%, P = 0.018, Table S3). Similar result was also seen assessed by IADL. Furthermore, patients with lower ASA scores were more likely to receive lymph node surgery (97.4% vs. 90.4%, P = 0.027, Table S3). 3.4 Adjuvant treatment decision by MDT according to age and CGA Table 1 Multidisciplinary team (MDT) treatment advice on adjuvant therapy according to age group in elderly breast cancer patients MDT advice on adjuvant therapy Cases, n (%) Groups P value Total 60–69 yrs 70–79 yrs ≥ 80 yrs Radiotherapy a Yes 102(92.7) 48(94.1) 44(97.8) 10(71.4) 0.017 No 8(7.3) 3(5.9) 1(2.2) 4(28.6) Chemotherapy Yes 89(42.2) 47(54) 39(38.2) 3(13.6) < 0.001 No 122(57.8) 40(46) 63(61.8) 19(86.4) Endocrine therapy b Yes 148(87.1) 60(85.7) 69(85.2) 19(100) 0.234 No 22(12.9) 10(14.3) 12(14.8) 0(0) Target therapy c Yes 15(78.9) 7(87.5) 7(70) 1(100) 0.675 No 4(21.1) 1(12.5) 3(30) 0(0) a Radiotherapy analyzed when T ≥ 3 or N + or having breast conserving surgery. b Endocrine therapy analyzed in ER + or PR + patients. c Target therapy analyzed in Her2 + patients. Significant P values (< 0.05) are in bold. Overall, there were 175 patients suggested receiving adjuvant therapy after MDT discussion. Number of patients suggested radiotherapy, chemotherapy, endocrine therapy, and target therapy were 102 (92.7%), 89 (42.2%), 148 (87.1%), and 15 (78.9%) respectively. Radiotherapy was recommended in 48 out of 51 (94.1%) patients who were 60–69 years, 44 out of 45 (97.8%) who were 70–79 years, and 10 out of 14 (71.4%) patients who aged > 80 years old ( P = 0.017, Table 1 ). Meanwhile, there were 47 out of 87 (54.0%), 39 out of 102 (38.2%), and 3 out of 22 (13.6%) patients who received chemotherapy recommendation in 60–69 years, 70–79 years and over 80 years age groups, respectively ( P < 0.001, Table 1 ). Regarding CGA, there was a significant difference in advice on radiotherapy based on scores of VES-13, BI, and ADL. Patients with fitter scores regarding VES-13 (95.7% vs. 77.8%, P = 0.021, Fig. 2 ), BI (96.7% vs. 75%, P = 0.003, Fig. 2 ), and ADL (96.3% vs. 83.9%, P = 0.035, Fig. 2 ) were more often received radiotherapy recommendation. The advice on adjuvant chemotherapy was differently distributed according to scores of VES-13, BI, and ECOG-PS. Patients with fitter scores of VES-13 (46.8% vs. 21.1%, P = 0.004, Fig. 2 ) and BI (45.6% vs. 27.5%, P = 0.037, Fig. 2 ) were more likely to be suggested with adjuvant chemotherapy. Whereas, chemotherapy was less likely to be recommended in patients with fitter scores of ECOG PS (39% vs. 62.1%, P = 0.02, Fig. 2 ). There was no significant difference regarding endocrine therapy and target therapy when grouped according to CGA scores. 3.5 Treatment adherence according to age and CGA Table 2 Multidisciplinary team (MDT) treatment advice adherence on adjuvant therapy by age group in elderly breast cancer patients Surgery choice Cases, n (%) Groups P value Total e 60–69 yrs 70–79 yrs ≥ 80 yrs Radiotherapy a Adherence 91(89.2) 48(100) 36(81.8) 7(70) 0.003 Non-adherence 11(10.8) 0(0) 8(18.2) 3(30) Chemotherapy Adherence 68(76.4) 38(80.9) 28(71.8) 2(66.7) 0.569 Non-adherence 21(23.6) 9(19.1) 11(28.2) 1(33.3) Endocrine therapy b Adherence 137(92.6) 59(98.3) 62(89.9) 16(84.2) 0.043 Non-adherence 11(7.4) 1(1.7) 7(10.1) 3(15.8) Target therapy c Adherence 14(73.7) 7(87.5) 6(60) 1(100) 0.494 Non-adherence 5(26.3) 1(12.5) 4(40) 0(0) Overall d Adherence 151(82.1) 68(89.5) 67(77) 16(76.2) 0.089 Non-adherence 33(17.9) 8(10.5) 20(23) 5(23.8) a Radiotherapy analyzed when T ≥ 3 or N + or having breast conserving surgery. b Endocrine therapy analyzed in ER + or PR + patients. c Target therapy analyzed when Her2+. d Overall adherence indicates that the actual treatment plan was the same as the one advised by MDT. e Total analyzed when MDT suggested the necessities of therapies. Significant P values (< 0.05) are in bold. The detailed adherence to treatment recommendation in different age groups are displayed in Table 2 . In general, there were 151 out of 184 (82.1%) patients adhering to suggestions on recommended adjuvant therapies. Moreover, overall adherence to radiotherapy, chemotherapy, endocrine therapy, and target therapy were 89.2% (91 out of 102), 76.4% (68 out of 89), 92.6% (137 out of 148), and 73.7% (14 out of 19), respectively. Treatment adherence to MDT recommendation did not differ among three age groups (89.5%, 77.0%, 76.2%, P = 0.089, Table 2 ). Adherence to radiotherapy was found with 100.0%, 81.8%, 70.0% in age groups of 60–69 years, 70–79 years, and above 80 years, respectively ( P = 0.003, Table 2 ). Regarding endocrine therapy, adherence rate was 98.3% (59/60), 89.9% (62/69), 84.2% (16/19) in 60–69 years, 70–79 years, and over 80 years age groups, respectively ( P = 0.043). In addition, the difference in adherence to chemotherapy and target therapy was not significant. Table 3. Comprehensive Geriatric Assessment (CGA) parameters and multidisciplinary team (MDT) treatment advice adherence to adjuvant therapy in elderly breast cancer patients CGA parameters Cases, n (%) Overall c P value Total b (n=184) Adherence (n=151) Non-adherence (n=33) VES-13 ≤2 151(82.1) 124(82.1) 27(81.8) 0.967 ≥3 33(17.9) 27(17.9) 6(18.2) BI 100 149(81) 120(79.5) 29(87.9) 0.244 ≤95 35(19) 31(20.5) 4(12.1) ECOG PS ≤1 157(85.3) 128(84.8) 29(87.9) 0.647 ≥2 27(14.7) 23(15.2) 4(12.1) ADL 26 129(70.1) 106(70.2) 23(69.7) 0.955 ≤25 55(29.9) 45(29.8) 10(30.3) IADL 23 101(54.9) 85(56.3) 16(48.5) 0.414 ≤22 83(45.1) 66(43.7) 17(51.5) 6-CIT 0-7 128(69.6) 110(72.8) 18(54.5) 0.104 8-9 25(13.6) 19(12.6) 6(18.2) 10-28 31(16.8) 22(14.6) 9(27.3) CCI-adjustment 0 148(80.4) 124(82.1) 24(72.7) 0.218 ≥1 36(19.6) 27(17.9) 9(27.3) ASA Score 1 101(54.9) 80(53) 21(63.6) 0.265 ≥2 83(45.1) 71(47) 12(36.4) G8 a >14 52(31.1) 44(31.7) 8(28.6) 0.748 ≤14 115(68.9) 95(68.3) 20(71.4) Abbreviations: VES-13=Vulnerable Elders Survey; BI=Barthel Index; ECOG PS=Eastern Cooperative Oncology Group Performance Status; ADL=Activities of Daily Living; IADL=Instrumental Activities of Daily Living; 6-CIT=6-Item Cognitive Impairment Test; CCI=Charlson’s Comorbidity Index; ASA Score=American Society of Anesthesiologists Score; G8=Geriatric-8 a G8 unknown in 18 patients engaged in MDT. b Total analyzed when MDT suggested the necessities of therapies. c Overall adherence indicates that the actual treatment plan was the same as the one advised by MDT. The relationship between CGA scores and treatment adherence was also analyzed. There was no significant difference between overall adherence and CGA scores (Table 3 ). In terms of different adjuvant treatment, better adjuvant chemotherapy compliance was only found in patients with fitter scores of CCI-adjustment (80.3% vs. 53.8%, P = 0.038, Fig. 3 ). Adherence to radiotherapy, endocrine therapy, or target therapy was not significantly different among patients with different CGA scores. 4. Discussion This study prospectively included elderly breast cancer patients to complete CGA composed of 9 questionnaires and attend MDT after surgery. We found that patients with lower scores of VES-13 and higher scores of BI, indicating a healthier condition, were more likely to receive adjuvant radiotherapy or chemotherapy recommendation after MDT discussion. Moreover, elderly patients who were considered fitter according to CCI-adjustment had a better adjuvant chemotherapy adherence with MDT recommendation, indicating CGA might play an important role in adjuvant treatment decision making and compliance with MDT in elderly breast cancer patients. In our study, older patients were more likely to have a score that represented unhealthy conditions, according to the VES-13, BI, ADL, IADL, and 6-CIT, which was also found in the Okonji’s study, focusing on breast cancer patients over 70[ 25 ]. More than 70% patients underwent mastectomy in our cohort, which was higher than previous reports[ 26 ], possibly due to the preference of surgery choices and patient’s willing[ 27 ]. Furthermore, SLNB is not necessary in all patients over 70 and with clinically negative lymph node[ 28 , 29 ]. In our study, 94.3% patients received ALN surgery, which was also relatively high and influenced by CGA status. Elderly patients with poor health condition were less likely to receive ALN surgery, possible explanations included that ALN status might not influence following systemic therapy and omission of axillary surgery could not only preserve arm function but also decrease health care costs both in time and finances[ 29 ]. Adjuvant radiotherapy has significantly improved survival through local-regional control in breast cancer, regardless of age[ 30 ]. Wang et al. reported that 57.6% of patients over 80 years were treated with radiotherapy and demonstrated that forgoing radiotherapy was associated with higher mortality rate, even in patients older than 90 years[ 31 ]. In our study, there were even much more patients (71.4%) over 80 years suggested adjuvant radiotherapy. Benefit of adjuvant chemotherapy in elderly patients was still open to question[ 32 , 33 ]. Giordano et al. found that benefit from adjuvant chemotherapy was only limited to lymph node-positive and ER negative disease in elderly patients[ 34 ]. There were 42.2% of patients recommended with adjuvant chemotherapy, which was much lower in patients with age over 80 years, indicating more evidence are needed to guide further adjuvant chemotherapy choice in elderly patients. Meanwhile, we found that adjuvant radiotherapy and chemotherapy were more likely to be recommended in patients with fitness in terms of VES-13, BI, and ADL, possibly due to the toxicity of these treatments [ 35 , 36 ]. Non-adherence to MDT recommendation is related to higher risk of recurrence and death[ 37 , 38 ]. In the current study, overall treatment adherence was 82.1%, which was higher than other studies, partly due to the MDT support system and our specialized nurse involving in MDT follow-up[ 39 , 40 ]. Meanwhile, we found that compliance rate decreased with the old age increasing, which was similar with the Water’s report[ 41 ]. Moreover, our results indicated that only CCI-adjustment score had influence on patients’ adherence to adjuvant chemotherapy. Comorbidity has always been a toughing problem in geriatric oncology, which can weaken the ability to comply with treatment regimens[ 42 ], indicating it is urgent to enhance health care system to improve treatment management in those elderly patients with high comorbidity. Interventions such as to enroll cardiologists, endocrinologists, nephrologist, and neurologists together into MDT panelist, so that a more individualized and proper treatment regimen can be made for these patients. To our knowledge, this is the first prospective study to evaluate the relationship between CGA and adjuvant treatment decision as well as treatment adherence in elderly breast cancer patients who participated in MDT discussion. However, there are several potential limitations in our study. First, this is a single-centered study with 211patients enrolled. More population from multicenter is necessary to increase credibility. Second, recruited patients have undergone a surgery and were not equally distributed among age groups, with only 22 patients over 80, which couldn’t represent this population accurately. Finally, other social and financial factors were not considered in multivariate analysis due to limited number of patients and relatively short follow-up period. In conclusion, our study found that age, scores of VES-13, BI, ECOG PS, and ADL could influence MDT advice on adjuvant therapy in elderly breast cancer patients. Age and scores of CCI-adjustment were related with adjuvant chemotherapy compliance with MDT recommendation in those elderly patients, warranting further clinical validation. Declarations Acknowledgements We would like to thank the assistance of Ms. Yidong Du in inputting SJTU-BCDB. Funding information The authors received the financial support from the National Natural Science Foundation of China (Grant Number: 82072937 and 82072897). Competing interests The authors declare no conflict of interests. Author Contributions XSC and KWS contributed to conception and design of the study; XSC, SJZ and YHJ contributed to the acquisition of data; YHJ analyzed the data and drafted the work; KWS and XSC provided financial support; XSC, ZX and JY revised it critically for important intellectual content. All authors read and approved the final manuscript. Data availability The data analyzed in the current study are available from the corresponding authors on reasonable request. Ethics approval and consent to participate The study was approved by the Ethical Committees of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, and informed consent was assigned. 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Saliba, D., et al., The Vulnerable Elders Survey: a tool for identifying vulnerable older people in the community. J Am Geriatr Soc, 2001. 49 (12): p. 1691-9.http://doi.org/10.1046/j.1532-5415.2001.49281.x. Mahoney, F.I. and D.W. Barthel, FUNCTIONAL EVALUATION: THE BARTHEL INDEX. Md State Med J, 1965. 14 : p. 61-5. Oken, M.M., et al., Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol, 1982. 5 (6): p. 649-55. Lawton, M.P. and E.M. Brody, Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist, 1969. 9 (3): p. 179-86. Brooke, P. and R. Bullock, Validation of a 6 item cognitive impairment test with a view to primary care usage. Int J Geriatr Psychiatry, 1999. 14 (11): p. 936-40. Charlson, M.E., et al., A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis, 1987. 40 (5): p. 373-83.http://doi.org/10.1016/0021-9681(87)90171-8. Owens, W.D., J.A. Felts, and E.L. Spitznagel, Jr., ASA physical status classifications: a study of consistency of ratings. Anesthesiology, 1978. 49 (4): p. 239-43.http://doi.org/10.1097/00000542-197810000-00003. Okonji, D.O., et al., Comprehensive geriatric assessment in 326 older women with early breast cancer. Br J Cancer, 2017. 117 (7): p. 925-931.http://doi.org/10.1038/bjc.2017.257. Lagendijk, M., et al., Breast conserving therapy and mastectomy revisited: Breast cancer-specific survival and the influence of prognostic factors in 129,692 patients. Int J Cancer, 2018. 142 (1): p. 165-175.http://doi.org/10.1002/ijc.31034. Sinnadurai, S., et al., Breast-conserving surgery versus mastectomy in young women with breast cancer in Asian settings. BJS Open, 2019. 3 (1): p. 48-55.http://doi.org/10.1002/bjs5.50111. Brackstone, M., et al., Management of the Axilla in Early-Stage Breast Cancer: Ontario Health (Cancer Care Ontario) and ASCO Guideline. J Clin Oncol, 2021. 39 (27): p. 3056-3082.http://doi.org/10.1200/jco.21.00934. Gentilini, O.D., et al., Sentinel Lymph Node Biopsy vs No Axillary Surgery in Patients With Small Breast Cancer and Negative Results on Ultrasonography of Axillary Lymph Nodes: The SOUND Randomized Clinical Trial. JAMA Oncol, 2023. 9 (11): p. 1557-1564.http://doi.org/10.1001/jamaoncol.2023.3759. Kunkler, I.H., et al., Breast-Conserving Surgery with or without Irradiation in Early Breast Cancer. N Engl J Med, 2023. 388 (7): p. 585-594.http://doi.org/10.1056/NEJMoa2207586. Wang, F., et al., Radiotherapy after breast-conserving surgery for elderly patients with early-stage breast cancer: A national registry-based study. Int J Cancer, 2021. 148 (4): p. 857-867.http://doi.org/10.1002/ijc.33265. Wu, Y., et al., Effect of adjuvant chemotherapy on the survival outcomes of elderly breast cancer: A retrospective cohort study based on SEER database. J Evid Based Med, 2022. 15 (4): p. 354-364.http://doi.org/10.1111/jebm.12506. Tamirisa, N., et al., Association of Chemotherapy With Survival in Elderly Patients With Multiple Comorbidities and Estrogen Receptor-Positive, Node-Positive Breast Cancer. JAMA Oncol, 2020. 6 (10): p. 1548-1554.http://doi.org/10.1001/jamaoncol.2020.2388. Giordano, S.H., et al., Use and outcomes of adjuvant chemotherapy in older women with breast cancer. J Clin Oncol, 2006. 24 (18): p. 2750-6.http://doi.org/10.1200/JCO.2005.02.3028. Mariano, C., et al., Predictors and effects of toxicity experienced by older adults with cancer receiving systemic therapy in a randomized clinical trial of geriatric assessment. J Geriatr Oncol, 2023. 14 (7): p. 101584.http://doi.org/10.1016/j.jgo.2023.101584. Wang, W., et al., Outcome and toxicity of radical radiotherapy or concurrent Chemoradiotherapy for elderly cervical cancer women. BMC Cancer, 2017. 17 (1): p. 510.http://doi.org/10.1186/s12885-017-3503-2. Makubate, B., et al., Cohort study of adherence to adjuvant endocrine therapy, breast cancer recurrence and mortality. Br J Cancer, 2013. 108 (7): p. 1515-24.http://doi.org/10.1038/bjc.2013.116. Formenti, S.C., et al., Inadequate adherence to radiotherapy in Latina immigrants with carcinoma of the cervix. Potential impact on disease free survival. Cancer, 1995. 75 (5): p. 1135-40.http://doi.org/10.1002/1097-0142(19950301)75:5<1135::aid-cncr2820750513>3.0.co;2-m. Dragvoll, I., et al., Predictors of adherence and the role of primary non-adherence in antihormonal treatment of breast cancer. BMC Cancer, 2022. 22 (1): p. 1247.http://doi.org/10.1186/s12885-022-10362-4. Zheng, D. and J. Thomas, 3rd, Adherence to and persistence with adjuvant hormone therapy, healthcare utilization, and healthcare costs among older women with breast cancer: A population-based longitudinal cohort study. J Geriatr Oncol, 2023. 14 (8): p. 101599.http://doi.org/10.1016/j.jgo.2023.101599. van de Water, W., et al., Adherence to treatment guidelines and survival in patients with early-stage breast cancer by age at diagnosis. Br J Surg, 2012. 99 (6): p. 813-20.http://doi.org/10.1002/bjs.8743. Søgaard, M., et al., The impact of comorbidity on cancer survival: a review. Clin Epidemiol, 2013. 5 (Suppl 1): p. 3-29.http://doi.org/10.2147/clep.S47150. Additional Declarations No competing interests reported. Supplementary Files SupplementaryMaterialBCRT.pdf Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-4201532\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":286613026,\"identity\":\"32ab6d25-c197-461d-a35e-f1d082f47e52\",\"order_by\":0,\"name\":\"Yihua Jin\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Ruijin Hospital, Shanghai Jiao Tong University School of Medicine\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Yihua\",\"middleName\":\"\",\"lastName\":\"Jin\",\"suffix\":\"\"},{\"id\":286613027,\"identity\":\"7509e700-a27d-4b9b-8953-beb52f2dea93\",\"order_by\":1,\"name\":\"Jing Yu\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Ruijin Hospital, Shanghai Jiao Tong University School of Medicine\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Jing\",\"middleName\":\"\",\"lastName\":\"Yu\",\"suffix\":\"\"},{\"id\":286613028,\"identity\":\"6f4bb924-5248-4449-baa0-14e0745a7f37\",\"order_by\":2,\"name\":\"Xu Zhang\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Ruijin Hospital, Shanghai Jiao Tong University School of Medicine\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Xu\",\"middleName\":\"\",\"lastName\":\"Zhang\",\"suffix\":\"\"},{\"id\":286613029,\"identity\":\"e6a53fa7-1066-4584-8ecf-aa6dbbc077c9\",\"order_by\":3,\"name\":\"Siji Zhu\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Ruijin Hospital, Shanghai Jiao Tong University School of Medicine\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Siji\",\"middleName\":\"\",\"lastName\":\"Zhu\",\"suffix\":\"\"},{\"id\":286613030,\"identity\":\"a1f8ac63-e2dc-4722-a586-ecb321435b1c\",\"order_by\":4,\"name\":\"Kunwei Shen\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Ruijin Hospital, Shanghai Jiao Tong University School of Medicine\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Kunwei\",\"middleName\":\"\",\"lastName\":\"Shen\",\"suffix\":\"\"},{\"id\":286613031,\"identity\":\"66f06a64-b471-4483-bd20-7a0428939a99\",\"order_by\":5,\"name\":\"Xiaosong Chen\",\"email\":\"data:image/png;base64,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\",\"orcid\":\"\",\"institution\":\"Ruijin Hospital, Shanghai Jiao Tong University School of Medicine\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Xiaosong\",\"middleName\":\"\",\"lastName\":\"Chen\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2024-04-01 15:20:10\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-4201532/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-4201532/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":54181325,\"identity\":\"7d97e723-e9bd-4e39-b12a-8f404116505a\",\"added_by\":\"auto\",\"created_at\":\"2024-04-05 16:34:08\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":101444,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eFlow chart of enrollment\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Fig.1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4201532/v1/8d254dc295359d34bf47921d.png\"},{\"id\":54181343,\"identity\":\"a8beec3c-3b7e-4faa-8660-d19176b182ae\",\"added_by\":\"auto\",\"created_at\":\"2024-04-05 16:34:10\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":393661,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eComprehensive Geriatric Assessment (CGA) parameters and multidisciplinary team treatment advice on radiotherapy, chemotherapy, endocrine therapy and target therapy. Radiotherapy analyzed in patients with T3 or N+ or having breast conserving surgery. Endocrine therapy analyzed in ER+ or PR+ patients. Target therapy analyzed in Her2+ patients. *P≤0.05, **P≤0.01. Abbreviations: VES-13=Vulnerable Elders Survey; BI=Barthel Index; ECOG PS=Eastern Cooperative Oncology Group Performance Status; ADL=Activities of Daily Living; IADL=Instrumental Activities of Daily Living; 6-CIT=6-Item Cognitive Impairment Test; CCI=Charlson’s Comorbidity Index; ASA Score=American Society of Anesthesiologists Score; G8=Geriatric-8.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Fig.2.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4201532/v1/7444c469a77b91d43768a072.png\"},{\"id\":54181329,\"identity\":\"9db69cd4-2eb9-467e-8686-313d7377f3fd\",\"added_by\":\"auto\",\"created_at\":\"2024-04-05 16:34:08\",\"extension\":\"png\",\"order_by\":3,\"title\":\"Figure 3\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":407039,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eComprehensive Geriatric Assessment (CGA) parameters and multidisciplinary treatment advice adherence on radiotherapy, chemotherapy, endocrine therapy and target therapy in breast cancer patients. (A)-(I) analyzed when MDT suggested the necessities of therapies. *P≤0.05. Abbreviations: VES-13=Vulnerable Elders Survey; BI=Barthel Index; ECOG PS=Eastern Cooperative Oncology Group Performance Status; ADL=Activities of Daily Living; IADL=Instrumental Activities of Daily Living; 6-CIT=6-Item Cognitive Impairment Test; CCI=Charlson’s Comorbidity Index; ASA Score=American Society of Anesthesiologists Score; G8=Geriatric-8.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Fig.3.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4201532/v1/cf5d245253713666427af660.png\"},{\"id\":58009783,\"identity\":\"fda1cffc-72de-4da8-afee-b2a1a09e0107\",\"added_by\":\"auto\",\"created_at\":\"2024-06-09 21:31:30\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1465415,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4201532/v1/a11dd03b-9e5a-47fb-b857-273b87225438.pdf\"},{\"id\":54181350,\"identity\":\"51385bd3-287b-4236-a887-550bfd32748d\",\"added_by\":\"auto\",\"created_at\":\"2024-04-05 16:34:11\",\"extension\":\"pdf\",\"order_by\":1,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":147361,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"SupplementaryMaterialBCRT.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4201532/v1/7ca0f1eec7ee55cc777481eb.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Association of comprehensive geriatric assessment with multidisciplinary treatment decision and adherence in elderly breast cancer patients\",\"fulltext\":[{\"header\":\"1. Introduction\",\"content\":\"\\u003cp\\u003eBreast cancer has been the leading diagnosed cancer in female since 1975, and it is estimated that there will be 297,790 new cases, and 43,170 deaths in 2023 [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]. Mortality rates of breast cancer continues to increase with age [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e]. Considering the complexity of cancer care, multidisciplinary team (MDT) strategy is widely used to improve coordination, communication, and decision making between health-care team members and patients[\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]. In a randomized clinical trial, adding an MDT discussion before chemotherapy initiation reduced the incidence rate of high-grade chemotherapy-related toxicity effects in elderly breast cancer patients[\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]. Moreover, locally advanced breast cancer patients also benefit from MDT with better local control and fewer relapses[\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]. A retrospective trial conducted in our center reported that compliance with MDT recommendations was closely related to overall survival (OS) and disease-free survival (DFS)[\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e]. However, older breast cancer patients tended to have poor compliance[\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eOlder patients are a highly heterogenous group, characterizing with many age-related conditions[\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e]. On the one hand, senescence remodels the tumor microenvironment, thus influencing the therapy response[\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e]. On the other hand, problems such as cognitive impairment, reduced mobility, polypharmacy, multimorbidity come along with aging [\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]. Comorbidities were closely associated with lower compliance[\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e]. Moreover, researches in growing numbers focus on undertreatment and overtreatment due to heterogeneity in geriatric oncological patients[\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e]. As life expectancy increases, the contraindication has been sharpening between the estimated surging numbers of geriatric breast cancer patients and the persisting scarcity of data from clinical trials for this population[\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e]. Comprehensive geriatric assessment (CGA), as a pivotal tool to uncover vulnerabilities and needs of elderly patients, might be beneficial in the design of personalized interventions and improvement of prognosis[\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eThe importance of integrating CGA into oncology clinical care has been reiterated by the American Society of Clinical Oncology (ASCO), the International Society of Geriatric Oncology (SIOG), and the European Society of Breast Cancer Specialists (EUSOMA)[\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e]. CGA, as a comprehensive and multidomain assessment (i.e., minimum functional status, mobility, nutritional status, mood, cognition, and comorbidities), has shown diverse benefits, including mortality prediction, treatment plan individualization, patient-related outcomes (PROs) emphasis, and possible cost-effectiveness[\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e]. However, only few percentages of oncologist used CGA into clinical practice, probably owing to lack of knowledge or training[\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e]. Therefore, there is still an urgent need for more researches to demonstrate the necessity of CGA.\\u003c/p\\u003e \\u003cp\\u003eIn current study, we aimed to prospectively evaluate the CGA status of elderly breast cancer patients, thus to analyze whether different CGA status would influence the decision-making as well as compliance with MDT.\\u003c/p\\u003e\"},{\"header\":\"2. Methods\",\"content\":\"\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e2.1 Data processing\\u003c/h2\\u003e \\u003cp\\u003ePatients were prospectively recruited between June 2019 and January 2020 from Shanghai Ruijin Hospital. Eligibility were as follows: patients aged over 60 years; received curative surgery of breast cancer after recruitment; attended the MDT discussion. Patients were excluded from the study if they refused biopsy for pathological diagnosis, being diagnosed with benign lesion, chose non-surgical treatment, or received curative surgery before CGA survey. Clinicopathological characteristics including medical history of cancer, family history of breast cancer, pathologic type, histologic grade, tumor size, lymph node involvement, and expression of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) and Ki-67 were extracted from the Shanghai Jiao Tong University Breast Cancer Database. The cut-off point for ER and PR expression was set at 1%. Meanwhile, tumors were considered as HER2-positive only if scored 3\\u0026thinsp;+\\u0026thinsp;by immunohistochemistry (IHC) or 2\\u0026thinsp;+\\u0026thinsp;by IHC and amplified by fluorescence in situ hybridization (FISH).Meanwhile, treatment details including type of surgery, MDT advice adjuvant treatment received, as well as the follow-up information were also retrieved.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec4\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e2.2 CGA assessment\\u003c/h2\\u003e \\u003cp\\u003eEach participant was asked to complete a panel of geriatric assessment tools through a smartphone app, which include: Vulnerable Elders Survey (VES-13)[\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e], Barthel Index (BI)[\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e], Eastern Cooperative Oncology Group Performance Status (ECOG PS)[\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e], Activities of Daily Living (ADL)[\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e], Instrumental Activities of Daily Living (IADL)[\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e], 6-Item Cognitive Impairment Test (6-CIT)[\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e], Charlson's Comorbidity Index (CCI)[\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e], and American Society of Anesthesiologists Score (ASA Score)[\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e]. Above scales were attached in the supplementary materials. Except for the one in 6-CIT, the thresholds for determination of fitness according to questionnaires were mainly based on population distribution by setting a cutoff value closest to the median. For 6-CIT, suggested stratifications for this questionnaire were used, that is normal if scoring 0\\u0026ndash;7, moderate cognitive impairment if scoring 8\\u0026ndash;9, and obvious cognitive impairment if scoring 10\\u0026ndash;28. To avoid the bias caused by age, CCI-adjustment was used when the score of age was removed from the final score of CCI.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec5\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e2.3 MDT Discussion\\u003c/h2\\u003e \\u003cp\\u003eAn MDT discussion is held routinely to formulate individualized adjuvant treatment recommendations for patients with early breast cancer who have undergone surgery as soon as the complete pathological report was achieved. Physicians from various disciplines constitute a panelist, including breast surgeons, medical oncologists, pathologists, radiation oncologists, and breast specialized nurses. A complete treatment recommendation is offered to patient after the MDT discussion, including radiotherapy (yes or no), chemotherapy (yes or no, drugs and cycles), endocrine therapy (yes or no, selective estrogen receptor modulator (SERM) or aromatase inhibitor (AI), with or without ovarian function suppression (OFS)), and HER2 target therapy (yes or no, trastuzumab alone or with pertuzumab).\\u003c/p\\u003e \\u003cp\\u003eRadiotherapy was only discussed among patients with T3 tumors, positive lymph node metastasis, or patients receiving breast conserving surgery. Chemotherapy was discussed among all patients. Endocrine therapy was only discussed among patients with hormone receptor (HR) positive tumors, and target therapy was discussed among patients with HER2 positive breast cancer.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec6\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e2.4 Measurement of non-adherence\\u003c/h2\\u003e \\u003cp\\u003eTreatment adherence was evaluated in all patients according to whether their actual treatment was the same as the one suggested by MDT discussion, which was evaluated by the physicians during outpatient service, or assessed by specialist nurse via phone calls. Non-adherence was defined in the following circumstances: (1) the patient refused to accept the prescribed regimen recommended by MDT discussion, (2) the patient chose a treatment plan different from the recommended one (using a different drug or different dose), (3) the patient failed to complete the whole recommended treatment plan. The adherence was investigated in each of the treatment patterns, including: radiotherapy, chemotherapy, endocrine therapy, and target therapy. The adherence was assessed only in patients who were suggested to receive the corresponding adjuvant therapy. The overall adherence was identified if the actual therapy was the same as the one recommended by MDT discussion in all the four treatments patterns. Otherwise, the overall non-adherence will be recognized.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec7\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e2.5 Statistical considerations\\u003c/h2\\u003e \\u003cp\\u003eClinicopathological characteristics were presented as patient number and percentage [n, (%)]. Results of CGA were presented as categorial variables. Distribution of the geriatric assessment among different age groups as well as patients\\u0026rsquo; adherence according to CGA results were calculated by Fisher\\u0026rsquo;s exact test. Two-side P-value of \\u0026lt;\\u0026thinsp;0.05 was considered statistically significant. Analysis was conducted using SPSS version 26 (SPSS Inc., Chicago, IL, USA) for Mac and the figure was created using GraphPad Prism 9 (GraphPad Prism, Inc., San Diego, CA, USA).\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"3. Results\",\"content\":\"\\u003cdiv id=\\\"Sec9\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e3.1 Basic characteristics\\u003c/h2\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003eOverall, there were 273 patients completed the CGA survey. Among whom, 215 patients underwent a breast cancer surgery and 211 patients attended the MDT after surgery (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e). Among these 211 patients, there were 207 females and 4 males. The median age was 71 years (range, 63\\u0026ndash;90). A total of 25 patients had a breast-related medical history and 3 of them have had breast cancer. History of malignancy was present in 9 patients and family history of breast cancer was present in 17 ones. There were 87 (41.2%), 102 (48.3%), and 22 (10.4%) patients categorized in the age group of 60\\u0026ndash;69 years, 70\\u0026ndash;79 years and above 80 years, respectively. Other patient and tumor detailed characteristics are listed in Table \\u003cspan refid=\\\"MOESM1\\\" class=\\\"InternalRef\\\"\\u003eS1\\u003c/span\\u003e. Invasive ductal carcinoma (IDC) was the most common pathologic type with 117(55.5%) patients in all age groups. There were 96(45.5%) patients had grade II disease. Tumors no more than 2.0cm were present in 126 (59.7%) patients. Lymph node metastasis was seen in 94 (44.5%) patients. There were 170 (80.6%) patients had an ER positive disease and 155 (73.5%) patients had a PR positive disease, while patients with a HER2 positive disease were only 19 (9.0%). High expression of Ki-67 (\\u0026ge;\\u0026thinsp;14%) was seen in 117(55.5%) patients. There was no significant difference of clinicopathological characteristics among three age groups.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec10\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e\\u003cem\\u003e3.2 CGA parameters scores according to age\\u003c/em\\u003e\\u003c/h2\\u003e \\u003cp\\u003eScores of certain geriatric assessments were significantly different among age groups, including VES-13, BI, ADL, IADL and 6-CIT. Regarding VES-13, older patients were more likely to have a higher score that represented unhealthy conditions (5.7% vs. 18.6% vs. 63.6% in age group of 60\\u0026ndash;69 years, 70\\u0026ndash;79 years, and above 80 years respectively, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001, Table S2). When using Barthel Index, older patients were more likely to have a lower score that represented unhealthy conditions (10.3% vs. 17.6% vs. 59.1% in age group of 60\\u0026ndash;69 years, 70\\u0026ndash;79 years, and above 80 years respectively, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001, Table S2). The results of ADL demonstrated that older patients tended to have difficulties in daily activities (18.4% vs. 28.4% vs. 68.2% in age group of 60\\u0026ndash;69 years, 70\\u0026ndash;79 years and above 80 years respectively, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001, Table S2). The similar conclusion was also drawn when using IADL. Furthermore, there was a concentrated distribution of older patients in high-score groups regarding 6-CIT (11.5% vs. 17.6% vs. 31.8% in age group of 60\\u0026ndash;69 years, 70\\u0026ndash;79 years, and above 80 years respectively, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.045, Table S2), indicating older patients were more likely to have a score that represented unhealthy conditions.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec11\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e3.3 Surgery choices according to age and CGA\\u003c/h2\\u003e \\u003cp\\u003eAmong 211 eligible patients, there were 150 (71.1%) and 61 (28.9%) patients receive mastectomy and breast conserving surgery, respectively. Overall, 29.9% (26 out of 87), 25.5% (26 out of 102), and 40.9% (9 out of 22) had breast conserving surgery in 60\\u0026ndash;69 years, 70\\u0026ndash;79 years, and over 80 years age groups, respectively (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.339). Axillary surgery was performed on 94.3% (199/211) of all patients, among whom, 149 (74.9%) underwent sentinel lymph node biopsy (SLNB) and 137 (68.8%) had axillary lymph node dissection (ALND). When grouped by age, 63 out of 87 patients aged 60\\u0026ndash;69 (72.4%), 73 out of 102 patients aged 70\\u0026ndash;79 (71.6%), and 13 out of 22 patients aged over 80 years (59.1%) received SLNB, respectively (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.452). Moreover, 55 out of 87 patients aged 60\\u0026ndash;69 (63.2%), 70 out of 102 patients aged 70\\u0026ndash;79 (68.6%), and 12 out of 22 patients aged over 80 years (54.5%) received ALND, respectively (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.414).\\u003c/p\\u003e \\u003cp\\u003eThere was no statistically significant difference in the choice of breast surgery among different groups of CGA scores. However, the choice of lymph node surgery was differently distributed according to the scores of ADL, IADL, and ASA Score. Regarding ADL, there was a higher tendency for patients with higher score to receive lymph node surgery (95.6% vs. 86.2%, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.018, Table S3). Similar result was also seen assessed by IADL. Furthermore, patients with lower ASA scores were more likely to receive lymph node surgery (97.4% vs. 90.4%, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.027, Table S3).\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec12\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e3.4 Adjuvant treatment decision by MDT according to age and CGA\\u003c/h2\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eMultidisciplinary team (MDT) treatment advice on adjuvant therapy according to age group in elderly breast cancer patients\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"6\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eMDT advice on adjuvant therapy\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eCases, n (%)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c5\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003eGroups\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eP\\u003c/em\\u003e value\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eTotal\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e60\\u0026ndash;69 yrs\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e70\\u0026ndash;79 yrs\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e\\u0026ge;\\u0026thinsp;80 yrs\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eRadiotherapy\\u003c/b\\u003e\\u003csup\\u003e\\u003cb\\u003ea\\u003c/b\\u003e\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e102(92.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e48(94.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e44(97.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e10(71.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e0.017\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e8(7.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3(5.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1(2.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e4(28.6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eChemotherapy\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e89(42.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e47(54)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e39(38.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e3(13.6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e122(57.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e40(46)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e63(61.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e19(86.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eEndocrine therapy\\u003c/b\\u003e\\u003csup\\u003e\\u003cb\\u003eb\\u003c/b\\u003e\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e148(87.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e60(85.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e69(85.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e19(100)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.234\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e22(12.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e10(14.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e12(14.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0(0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eTarget therapy\\u003c/b\\u003e\\u003csup\\u003e\\u003cb\\u003ec\\u003c/b\\u003e\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e15(78.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e7(87.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e7(70)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1(100)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.675\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e4(21.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1(12.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e3(30)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0(0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"6\\\" nameend=\\\"c6\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003csup\\u003ea\\u003c/sup\\u003eRadiotherapy analyzed when T\\u0026thinsp;\\u0026ge;\\u0026thinsp;3 or N\\u0026thinsp;+\\u0026thinsp;or having breast conserving surgery.\\u003c/p\\u003e \\u003cp\\u003e\\u003csup\\u003eb\\u003c/sup\\u003eEndocrine therapy analyzed in ER\\u0026thinsp;+\\u0026thinsp;or PR\\u0026thinsp;+\\u0026thinsp;patients.\\u003c/p\\u003e \\u003cp\\u003e\\u003csup\\u003ec\\u003c/sup\\u003eTarget therapy analyzed in Her2\\u0026thinsp;+\\u0026thinsp;patients.\\u003c/p\\u003e \\u003cp\\u003eSignificant P values (\\u0026lt;\\u0026thinsp;0.05) are in bold.\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eOverall, there were 175 patients suggested receiving adjuvant therapy after MDT discussion. Number of patients suggested radiotherapy, chemotherapy, endocrine therapy, and target therapy were 102 (92.7%), 89 (42.2%), 148 (87.1%), and 15 (78.9%) respectively. Radiotherapy was recommended in 48 out of 51 (94.1%) patients who were 60\\u0026ndash;69 years, 44 out of 45 (97.8%) who were 70\\u0026ndash;79 years, and 10 out of 14 (71.4%) patients who aged\\u0026thinsp;\\u0026gt;\\u0026thinsp;80 years old (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.017, Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e). Meanwhile, there were 47 out of 87 (54.0%), 39 out of 102 (38.2%), and 3 out of 22 (13.6%) patients who received chemotherapy recommendation in 60\\u0026ndash;69 years, 70\\u0026ndash;79 years and over 80 years age groups, respectively (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001, Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eRegarding CGA, there was a significant difference in advice on radiotherapy based on scores of VES-13, BI, and ADL. Patients with fitter scores regarding VES-13 (95.7% vs. 77.8%, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.021, Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e), BI (96.7% vs. 75%, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.003, Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e), and ADL (96.3% vs. 83.9%, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.035, Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e) were more often received radiotherapy recommendation. The advice on adjuvant chemotherapy was differently distributed according to scores of VES-13, BI, and ECOG-PS. Patients with fitter scores of VES-13 (46.8% vs. 21.1%, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.004, Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e) and BI (45.6% vs. 27.5%, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.037, Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e) were more likely to be suggested with adjuvant chemotherapy. Whereas, chemotherapy was less likely to be recommended in patients with fitter scores of ECOG PS (39% vs. 62.1%, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.02, Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e). There was no significant difference regarding endocrine therapy and target therapy when grouped according to CGA scores.\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec13\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e3.5 Treatment adherence according to age and CGA\\u003c/h2\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eMultidisciplinary team (MDT) treatment advice adherence on adjuvant therapy by age group in elderly breast cancer patients\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"6\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eSurgery choice\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eCases, n (%)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c5\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003eGroups\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eP\\u003c/em\\u003e value\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eTotal\\u003csup\\u003ee\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e60\\u0026ndash;69 yrs\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e70\\u0026ndash;79 yrs\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e\\u0026ge;\\u0026thinsp;80 yrs\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eRadiotherapy\\u003c/b\\u003e\\u003csup\\u003e\\u003cb\\u003ea\\u003c/b\\u003e\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAdherence\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e91(89.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e48(100)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e36(81.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e7(70)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e0.003\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNon-adherence\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e11(10.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0(0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e8(18.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e3(30)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eChemotherapy\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAdherence\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e68(76.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e38(80.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e28(71.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e2(66.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.569\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNon-adherence\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e21(23.6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e9(19.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e11(28.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1(33.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eEndocrine therapy\\u003c/b\\u003e\\u003csup\\u003e\\u003cb\\u003eb\\u003c/b\\u003e\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAdherence\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e137(92.6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e59(98.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e62(89.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e16(84.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e0.043\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNon-adherence\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e11(7.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1(1.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e7(10.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e3(15.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eTarget therapy\\u003c/b\\u003e\\u003csup\\u003e\\u003cb\\u003ec\\u003c/b\\u003e\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAdherence\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e14(73.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e7(87.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e6(60)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1(100)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.494\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNon-adherence\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e5(26.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1(12.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e4(40)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0(0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eOverall\\u003c/b\\u003e\\u003csup\\u003e\\u003cb\\u003ed\\u003c/b\\u003e\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAdherence\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e151(82.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e68(89.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e67(77)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e16(76.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.089\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNon-adherence\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e33(17.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e8(10.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e20(23)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e5(23.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"6\\\" nameend=\\\"c6\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003csup\\u003ea\\u003c/sup\\u003eRadiotherapy analyzed when T\\u0026thinsp;\\u0026ge;\\u0026thinsp;3 or N\\u0026thinsp;+\\u0026thinsp;or having breast conserving surgery.\\u003c/p\\u003e \\u003cp\\u003e\\u003csup\\u003eb\\u003c/sup\\u003eEndocrine therapy analyzed in ER\\u0026thinsp;+\\u0026thinsp;or PR\\u0026thinsp;+\\u0026thinsp;patients.\\u003c/p\\u003e \\u003cp\\u003e\\u003csup\\u003ec\\u003c/sup\\u003eTarget therapy analyzed when Her2+. \\u003c/p\\u003e \\u003cp\\u003e\\u003csup\\u003ed\\u003c/sup\\u003eOverall adherence indicates that the actual treatment plan was the same as the one advised by MDT.\\u003c/p\\u003e \\u003cp\\u003e\\u003csup\\u003ee\\u003c/sup\\u003eTotal analyzed when MDT suggested the necessities of therapies.\\u003c/p\\u003e \\u003cp\\u003eSignificant P values (\\u0026lt;\\u0026thinsp;0.05) are in bold.\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eThe detailed adherence to treatment recommendation in different age groups are displayed in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e. In general, there were 151 out of 184 (82.1%) patients adhering to suggestions on recommended adjuvant therapies. Moreover, overall adherence to radiotherapy, chemotherapy, endocrine therapy, and target therapy were 89.2% (91 out of 102), 76.4% (68 out of 89), 92.6% (137 out of 148), and 73.7% (14 out of 19), respectively. Treatment adherence to MDT recommendation did not differ among three age groups (89.5%, 77.0%, 76.2%, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.089, Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e). Adherence to radiotherapy was found with 100.0%, 81.8%, 70.0% in age groups of 60\\u0026ndash;69 years, 70\\u0026ndash;79 years, and above 80 years, respectively (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.003, Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e). Regarding endocrine therapy, adherence rate was 98.3% (59/60), 89.9% (62/69), 84.2% (16/19) in 60\\u0026ndash;69 years, 70\\u0026ndash;79 years, and over 80 years age groups, respectively (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.043). In addition, the difference in adherence to chemotherapy and target therapy was not significant.\\u003c/p\\u003e\\n\\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" align=\\\"\\\" width=\\\"627\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"100%\\\" colspan=\\\"6\\\" valign=\\\"bottom\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTable 3.\\u0026nbsp;\\u003c/strong\\u003eComprehensive Geriatric Assessment (CGA) parameters and multidisciplinary team (MDT) treatment advice adherence to adjuvant therapy in elderly breast cancer patients\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.08626198083067%\\\" rowspan=\\\"2\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eCGA parameters\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.05111821086262%\\\"\\u003e\\n \\u003cp\\u003eCases, n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"49.840255591054316%\\\" colspan=\\\"3\\\"\\u003e\\n \\u003cp\\u003eOverall\\u003csup\\u003ec\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.022364217252397%\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eP\\u0026nbsp;\\u003c/em\\u003evalue\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"22.874493927125506%\\\"\\u003e\\n \\u003cp\\u003eTotal\\u003csup\\u003eb\\u003c/sup\\u003e (n=184)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"28.74493927125506%\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eAdherence (n=151)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"34.412955465587046%\\\"\\u003e\\n \\u003cp\\u003eNon-adherence (n=33)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.96761133603239%\\\"\\u003e\\n \\u003cp\\u003e \\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.08626198083067%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eVES-13\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.05111821086262%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd width=\\\"26.996805111821086%\\\" colspan=\\\"2\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd width=\\\"22.843450479233226%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd width=\\\"11.022364217252397%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.08626198083067%\\\"\\u003e\\n \\u003cp\\u003e\\u0026le;2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.05111821086262%\\\"\\u003e\\n \\u003cp\\u003e151(82.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"26.996805111821086%\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e124(82.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"22.843450479233226%\\\"\\u003e\\n \\u003cp\\u003e27(81.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.022364217252397%\\\"\\u003e\\n \\u003cp\\u003e0.967\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.08626198083067%\\\"\\u003e\\n \\u003cp\\u003e\\u0026ge;3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.05111821086262%\\\"\\u003e\\n \\u003cp\\u003e33(17.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"26.996805111821086%\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e27(17.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"22.843450479233226%\\\"\\u003e\\n \\u003cp\\u003e6(18.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.022364217252397%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.08626198083067%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eBI\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.05111821086262%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd width=\\\"26.996805111821086%\\\" colspan=\\\"2\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd width=\\\"22.843450479233226%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd width=\\\"11.022364217252397%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.08626198083067%\\\"\\u003e\\n \\u003cp\\u003e100\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.05111821086262%\\\"\\u003e\\n \\u003cp\\u003e149(81)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"26.996805111821086%\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e120(79.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"22.843450479233226%\\\"\\u003e\\n \\u003cp\\u003e29(87.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.022364217252397%\\\"\\u003e\\n \\u003cp\\u003e0.244\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.08626198083067%\\\"\\u003e\\n \\u003cp\\u003e\\u0026le;95\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.05111821086262%\\\"\\u003e\\n \\u003cp\\u003e35(19)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"26.996805111821086%\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e31(20.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"22.843450479233226%\\\"\\u003e\\n \\u003cp\\u003e4(12.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.022364217252397%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.08626198083067%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eECOG PS\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.05111821086262%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd width=\\\"26.996805111821086%\\\" colspan=\\\"2\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd width=\\\"22.843450479233226%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd width=\\\"11.022364217252397%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.08626198083067%\\\"\\u003e\\n \\u003cp\\u003e\\u0026le;1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.05111821086262%\\\"\\u003e\\n \\u003cp\\u003e157(85.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"26.996805111821086%\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e128(84.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"22.843450479233226%\\\"\\u003e\\n \\u003cp\\u003e29(87.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.022364217252397%\\\"\\u003e\\n \\u003cp\\u003e0.647\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.08626198083067%\\\"\\u003e\\n \\u003cp\\u003e\\u0026ge;2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.05111821086262%\\\"\\u003e\\n \\u003cp\\u003e27(14.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"26.996805111821086%\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e23(15.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"22.843450479233226%\\\"\\u003e\\n \\u003cp\\u003e4(12.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.022364217252397%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.08626198083067%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eADL\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.05111821086262%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd width=\\\"26.996805111821086%\\\" colspan=\\\"2\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd width=\\\"22.843450479233226%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd width=\\\"11.022364217252397%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.08626198083067%\\\"\\u003e\\n \\u003cp\\u003e26\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.05111821086262%\\\"\\u003e\\n \\u003cp\\u003e129(70.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"26.996805111821086%\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e106(70.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"22.843450479233226%\\\"\\u003e\\n \\u003cp\\u003e23(69.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.022364217252397%\\\"\\u003e\\n \\u003cp\\u003e0.955\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.08626198083067%\\\"\\u003e\\n \\u003cp\\u003e\\u0026le;25\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.05111821086262%\\\"\\u003e\\n \\u003cp\\u003e55(29.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"26.996805111821086%\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e45(29.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"22.843450479233226%\\\"\\u003e\\n \\u003cp\\u003e10(30.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.022364217252397%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.08626198083067%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eIADL\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.05111821086262%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd width=\\\"26.996805111821086%\\\" colspan=\\\"2\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd width=\\\"22.843450479233226%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd width=\\\"11.022364217252397%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.08626198083067%\\\"\\u003e\\n \\u003cp\\u003e23\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.05111821086262%\\\"\\u003e\\n \\u003cp\\u003e101(54.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"26.996805111821086%\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e85(56.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"22.843450479233226%\\\"\\u003e\\n \\u003cp\\u003e16(48.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.022364217252397%\\\"\\u003e\\n \\u003cp\\u003e0.414\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.08626198083067%\\\"\\u003e\\n \\u003cp\\u003e\\u0026le;22\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.05111821086262%\\\"\\u003e\\n \\u003cp\\u003e83(45.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"26.996805111821086%\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e66(43.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"22.843450479233226%\\\"\\u003e\\n \\u003cp\\u003e17(51.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.022364217252397%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.08626198083067%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e6-CIT\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.05111821086262%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd width=\\\"26.996805111821086%\\\" colspan=\\\"2\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd width=\\\"22.843450479233226%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd width=\\\"11.022364217252397%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.08626198083067%\\\"\\u003e\\n \\u003cp\\u003e0-7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.05111821086262%\\\"\\u003e\\n \\u003cp\\u003e128(69.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"26.996805111821086%\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e110(72.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"22.843450479233226%\\\"\\u003e\\n \\u003cp\\u003e18(54.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.022364217252397%\\\"\\u003e\\n \\u003cp\\u003e0.104\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.08626198083067%\\\"\\u003e\\n \\u003cp\\u003e8-9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.05111821086262%\\\"\\u003e\\n \\u003cp\\u003e25(13.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"26.996805111821086%\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e19(12.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"22.843450479233226%\\\"\\u003e\\n \\u003cp\\u003e6(18.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.022364217252397%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.08626198083067%\\\"\\u003e\\n \\u003cp\\u003e10-28\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.05111821086262%\\\"\\u003e\\n \\u003cp\\u003e31(16.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"26.996805111821086%\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e22(14.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"22.843450479233226%\\\"\\u003e\\n \\u003cp\\u003e9(27.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.022364217252397%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.08626198083067%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCCI-adjustment\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.05111821086262%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd width=\\\"26.996805111821086%\\\" colspan=\\\"2\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd width=\\\"22.843450479233226%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd width=\\\"11.022364217252397%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.08626198083067%\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.05111821086262%\\\"\\u003e\\n \\u003cp\\u003e148(80.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"26.996805111821086%\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e124(82.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"22.843450479233226%\\\"\\u003e\\n \\u003cp\\u003e24(72.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.022364217252397%\\\"\\u003e\\n \\u003cp\\u003e0.218\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.08626198083067%\\\"\\u003e\\n \\u003cp\\u003e\\u0026ge;1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.05111821086262%\\\"\\u003e\\n \\u003cp\\u003e36(19.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"26.996805111821086%\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e27(17.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"22.843450479233226%\\\"\\u003e\\n \\u003cp\\u003e9(27.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.022364217252397%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.08626198083067%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eASA Score\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.05111821086262%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd width=\\\"26.996805111821086%\\\" colspan=\\\"2\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd width=\\\"22.843450479233226%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd width=\\\"11.022364217252397%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.08626198083067%\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.05111821086262%\\\"\\u003e\\n \\u003cp\\u003e101(54.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"26.996805111821086%\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e80(53)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"22.843450479233226%\\\"\\u003e\\n \\u003cp\\u003e21(63.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.022364217252397%\\\"\\u003e\\n \\u003cp\\u003e0.265\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.08626198083067%\\\"\\u003e\\n \\u003cp\\u003e\\u0026ge;2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.05111821086262%\\\"\\u003e\\n \\u003cp\\u003e83(45.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"26.996805111821086%\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e71(47)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"22.843450479233226%\\\"\\u003e\\n \\u003cp\\u003e12(36.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.022364217252397%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.08626198083067%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eG8\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.05111821086262%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd width=\\\"26.996805111821086%\\\" colspan=\\\"2\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd width=\\\"22.843450479233226%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd width=\\\"11.022364217252397%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.08626198083067%\\\"\\u003e\\n \\u003cp\\u003e\\u0026gt;14\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.05111821086262%\\\"\\u003e\\n \\u003cp\\u003e52(31.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"26.996805111821086%\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e44(31.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"22.843450479233226%\\\"\\u003e\\n \\u003cp\\u003e8(28.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.022364217252397%\\\"\\u003e\\n \\u003cp\\u003e0.748\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.08626198083067%\\\"\\u003e\\n \\u003cp\\u003e\\u0026le;14\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.05111821086262%\\\"\\u003e\\n \\u003cp\\u003e115(68.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"26.996805111821086%\\\" colspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e95(68.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"22.843450479233226%\\\"\\u003e\\n \\u003cp\\u003e20(71.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.022364217252397%\\\"\\u003e\\n \\u003cp\\u003e \\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"100%\\\" colspan=\\\"6\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eAbbreviations: VES-13=Vulnerable Elders Survey; BI=Barthel Index; ECOG PS=Eastern Cooperative Oncology Group Performance Status; ADL=Activities of Daily Living; IADL=Instrumental Activities of Daily Living; 6-CIT=6-Item Cognitive Impairment Test; CCI=Charlson\\u0026rsquo;s Comorbidity Index; ASA Score=American Society of Anesthesiologists Score; G8=Geriatric-8\\u003cbr\\u003e\\u003csup\\u003ea\\u003c/sup\\u003eG8 unknown in 18 patients engaged in MDT.\\u003cbr\\u003e\\u003csup\\u003eb\\u003c/sup\\u003eTotal analyzed when MDT suggested the necessities of therapies.\\u003cbr\\u003e\\u003csup\\u003ec\\u003c/sup\\u003eOverall adherence indicates that the actual treatment plan was the same as the one advised by MDT.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\u003cp\\u003eThe relationship between CGA scores and treatment adherence was also analyzed. There was no significant difference between overall adherence and CGA scores (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e). In terms of different adjuvant treatment, better adjuvant chemotherapy compliance was only found in patients with fitter scores of CCI-adjustment (80.3% vs. 53.8%, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.038, Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e). Adherence to radiotherapy, endocrine therapy, or target therapy was not significantly different among patients with different CGA scores.\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"4. Discussion\",\"content\":\"\\u003cp\\u003eThis study prospectively included elderly breast cancer patients to complete CGA composed of 9 questionnaires and attend MDT after surgery. We found that patients with lower scores of VES-13 and higher scores of BI, indicating a healthier condition, were more likely to receive adjuvant radiotherapy or chemotherapy recommendation after MDT discussion. Moreover, elderly patients who were considered fitter according to CCI-adjustment had a better adjuvant chemotherapy adherence with MDT recommendation, indicating CGA might play an important role in adjuvant treatment decision making and compliance with MDT in elderly breast cancer patients.\\u003c/p\\u003e \\u003cp\\u003eIn our study, older patients were more likely to have a score that represented unhealthy conditions, according to the VES-13, BI, ADL, IADL, and 6-CIT, which was also found in the Okonji\\u0026rsquo;s study, focusing on breast cancer patients over 70[\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e]. More than 70% patients underwent mastectomy in our cohort, which was higher than previous reports[\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e], possibly due to the preference of surgery choices and patient\\u0026rsquo;s willing[\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e]. Furthermore, SLNB is not necessary in all patients over 70 and with clinically negative lymph node[\\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e]. In our study, 94.3% patients received ALN surgery, which was also relatively high and influenced by CGA status. Elderly patients with poor health condition were less likely to receive ALN surgery, possible explanations included that ALN status might not influence following systemic therapy and omission of axillary surgery could not only preserve arm function but also decrease health care costs both in time and finances[\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eAdjuvant radiotherapy has significantly improved survival through local-regional control in breast cancer, regardless of age[\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e]. Wang et al. reported that 57.6% of patients over 80 years were treated with radiotherapy and demonstrated that forgoing radiotherapy was associated with higher mortality rate, even in patients older than 90 years[\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e]. In our study, there were even much more patients (71.4%) over 80 years suggested adjuvant radiotherapy. Benefit of adjuvant chemotherapy in elderly patients was still open to question[\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e]. Giordano et al. found that benefit from adjuvant chemotherapy was only limited to lymph node-positive and ER negative disease in elderly patients[\\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e]. There were 42.2% of patients recommended with adjuvant chemotherapy, which was much lower in patients with age over 80 years, indicating more evidence are needed to guide further adjuvant chemotherapy choice in elderly patients. Meanwhile, we found that adjuvant radiotherapy and chemotherapy were more likely to be recommended in patients with fitness in terms of VES-13, BI, and ADL, possibly due to the toxicity of these treatments [\\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eNon-adherence to MDT recommendation is related to higher risk of recurrence and death[\\u003cspan citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR38\\\" class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e]. In the current study, overall treatment adherence was 82.1%, which was higher than other studies, partly due to the MDT support system and our specialized nurse involving in MDT follow-up[\\u003cspan citationid=\\\"CR39\\\" class=\\\"CitationRef\\\"\\u003e39\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR40\\\" class=\\\"CitationRef\\\"\\u003e40\\u003c/span\\u003e]. Meanwhile, we found that compliance rate decreased with the old age increasing, which was similar with the Water\\u0026rsquo;s report[\\u003cspan citationid=\\\"CR41\\\" class=\\\"CitationRef\\\"\\u003e41\\u003c/span\\u003e]. Moreover, our results indicated that only CCI-adjustment score had influence on patients\\u0026rsquo; adherence to adjuvant chemotherapy. Comorbidity has always been a toughing problem in geriatric oncology, which can weaken the ability to comply with treatment regimens[\\u003cspan citationid=\\\"CR42\\\" class=\\\"CitationRef\\\"\\u003e42\\u003c/span\\u003e], indicating it is urgent to enhance health care system to improve treatment management in those elderly patients with high comorbidity. Interventions such as to enroll cardiologists, endocrinologists, nephrologist, and neurologists together into MDT panelist, so that a more individualized and proper treatment regimen can be made for these patients.\\u003c/p\\u003e \\u003cp\\u003eTo our knowledge, this is the first prospective study to evaluate the relationship between CGA and adjuvant treatment decision as well as treatment adherence in elderly breast cancer patients who participated in MDT discussion. However, there are several potential limitations in our study. First, this is a single-centered study with 211patients enrolled. More population from multicenter is necessary to increase credibility. Second, recruited patients have undergone a surgery and were not equally distributed among age groups, with only 22 patients over 80, which couldn\\u0026rsquo;t represent this population accurately. Finally, other social and financial factors were not considered in multivariate analysis due to limited number of patients and relatively short follow-up period.\\u003c/p\\u003e \\u003cp\\u003eIn conclusion, our study found that age, scores of VES-13, BI, ECOG PS, and ADL could influence MDT advice on adjuvant therapy in elderly breast cancer patients. Age and scores of CCI-adjustment were related with adjuvant chemotherapy compliance with MDT recommendation in those elderly patients, warranting further clinical validation.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgements\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eWe would like to thank the assistance of Ms. Yidong Du in inputting SJTU-BCDB.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding information\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors received the financial support from the National Natural Science Foundation of China (Grant Number: 82072937 and 82072897).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare no conflict of interests.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthor Contributions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eXSC and KWS contributed to conception and design of the study; XSC, SJZ and YHJ contributed to the acquisition of data; YHJ analyzed the data and drafted the work; KWS and XSC provided financial support; XSC, ZX and JY revised it critically for important intellectual content. All authors read and approved the final manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eData availability\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe data analyzed in the current study are available from the corresponding authors\\u003c/p\\u003e\\n\\u003cp\\u003eon reasonable request.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eEthics approval and consent to participate\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe study was approved by the Ethical Committees of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, and informed consent was assigned. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eSiegel, R.L., et al., \\u003cem\\u003eCancer statistics, 2023.\\u003c/em\\u003e CA Cancer J Clin, 2023. \\u003cstrong\\u003e73\\u003c/strong\\u003e(1): p. 17-48.http://doi.org/10.3322/caac.21763.\\u003c/li\\u003e\\n\\u003cli\\u003eGiaquinto, A.N., et al., \\u003cem\\u003eBreast Cancer Statistics, 2022.\\u003c/em\\u003e CA Cancer J Clin, 2022. \\u003cstrong\\u003e72\\u003c/strong\\u003e(6): p. 524-541.http://doi.org/10.3322/caac.21754.\\u003c/li\\u003e\\n\\u003cli\\u003eFleissig, A., et al., \\u003cem\\u003eMultidisciplinary teams in cancer care: are they effective in the UK?\\u003c/em\\u003e Lancet Oncol, 2006. \\u003cstrong\\u003e7\\u003c/strong\\u003e(11): p. 935-43.http://doi.org/10.1016/s1470-2045(06)70940-8.\\u003c/li\\u003e\\n\\u003cli\\u003eLi, D., et al., \\u003cem\\u003eGeriatric Assessment-Driven Intervention (GAIN) on Chemotherapy-Related Toxic Effects in Older Adults With Cancer: A Randomized Clinical Trial.\\u003c/em\\u003e JAMA Oncol, 2021. \\u003cstrong\\u003e7\\u003c/strong\\u003e(11): p. e214158.http://doi.org/10.1001/jamaoncol.2021.4158.\\u003c/li\\u003e\\n\\u003cli\\u003eAebi, S., P. 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Thomas, 3rd, \\u003cem\\u003eAdherence to and persistence with adjuvant hormone therapy, healthcare utilization, and healthcare costs among older women with breast cancer: A population-based longitudinal cohort study.\\u003c/em\\u003e J Geriatr Oncol, 2023. \\u003cstrong\\u003e14\\u003c/strong\\u003e(8): p. 101599.http://doi.org/10.1016/j.jgo.2023.101599.\\u003c/li\\u003e\\n\\u003cli\\u003evan de Water, W., et al., \\u003cem\\u003eAdherence to treatment guidelines and survival in patients with early-stage breast cancer by age at diagnosis.\\u003c/em\\u003e Br J Surg, 2012. \\u003cstrong\\u003e99\\u003c/strong\\u003e(6): p. 813-20.http://doi.org/10.1002/bjs.8743.\\u003c/li\\u003e\\n\\u003cli\\u003eS\\u0026oslash;gaard, M., et al., \\u003cem\\u003eThe impact of comorbidity on cancer survival: a review.\\u003c/em\\u003e Clin Epidemiol, 2013. \\u003cstrong\\u003e5\\u003c/strong\\u003e(Suppl 1): p. 3-29.http://doi.org/10.2147/clep.S47150.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Older Patients, Breast cancer, Comprehensive geriatric assessments, Multidisciplinary treatment, Adjuvant therapy, Adherence\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-4201532/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-4201532/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003ePurpose\\u003c/h2\\u003e \\u003cp\\u003eTo assess the association of comprehensive geriatric assessments (CGA) and multidisciplinary team (MDT) treatment decision and adherence in elderly breast cancer patients.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e \\u003cp\\u003eAged\\u0026thinsp;\\u0026ge;\\u0026thinsp;60 patients were prospectively enrolled between June 2019 and January 2020. CGA was surveyed by 9 questionnaires before breast cancer surgery. Adjuvant treatment decisions were made by MDT discussion. Factors associated with adjuvant treatment decision were analyzed. Patients\\u0026rsquo; adherence to MDT decision according to CGA were also analyzed.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e \\u003cp\\u003eA total of 211 patients were included: 87 (41.2%), 102 (48.3%), and 22 (10.4%) patients with age between 60\\u0026ndash;69, 70\\u0026ndash;79, and over 80, respectively. Patients with lower scores of VES-13 (95.7% vs 77.8%, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.021) and higher scores of BI (96.7% vs 75%, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.003) were more likely to be recommended with adjuvant radiotherapy. Rates of adjuvant chemotherapy recommendation was also higher for patients with lower VES score (46.8% vs 21.1%, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.004) and higher BI score (45.6% vs 27.5%, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.037). Adherence to adjuvant chemotherapy recommendation was found better in patients with fitter scores of CCI-adjustment (80.3% vs 53.8%, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.038)\\u003c/p\\u003e\\u003ch2\\u003eConclusion\\u003c/h2\\u003e \\u003cp\\u003eCGA was associated with adjuvant radiotherapy MDT decision, which also influenced the adherence to MDT adjuvant chemotherapy recommendation in elderly breast cancer patients.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Association of comprehensive geriatric assessment with multidisciplinary treatment decision and adherence in elderly breast cancer patients\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2024-04-05 16:32:38\",\"doi\":\"10.21203/rs.3.rs-4201532/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"4aac03e9-28bc-4796-9bb2-8b178dbd6fcc\",\"owner\":[],\"postedDate\":\"April 5th, 2024\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2024-06-09T21:23:23+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2024-04-05 16:32:38\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-4201532\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-4201532\",\"identity\":\"rs-4201532\",\"version\":[\"v1\"]},\"buildId\":\"qtupq5eGEP_6zYnWcrvyt\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}