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Frailty is defined as a multidimensional, heterogeneous and dynamic condition, that could affect patient’s functional capabilities. Very often older patients are considered frail and not included in clinical trial due to the incidence of age–related concomitant pathologies, even if cancers, including breast cancer (BC), are increasingly prevalent in older patients. A comprehensive multidisciplinary assessment in this setting is important: in fact the European Society of Breast Cancer Specialists (EUSOMA) and the International Society of Geriatric Oncology (SIOG) recommends that decision making should not be driven by age alone, but should involve different specialists evaluations. The aim of the study was the identification frail patients with BC, candidate for curative radiotherapy (RT), and to measure through an oncogeriatric multidimensional assessment the impact of frailty on toxicities and treatment adherence.

In our EUSOMA certified Center, a prospective observational study was designed for all patients with > 75 years, candidate for curative RT. All the patients with BC every week are discussed in a multidisciplinary meeting.  Frail patients are identified by the radiation oncologist, before RT, using Geriatric 8 questionnaire (G8q). Patients resulted frail (score ≤ 14) undergo a multidimensional geriatric assessment, investigating cognitive (MMSE, GDS), functional (ADL, IADL, Tinetti), nutritional (MNA short) domains, to define the frailty phenotype. G8q is repeated at the end of RT.

From December 2019 to September 2021 a total of 175 oncologic patients were screened. In our current analysis, we considered 28 breast cancer patients (median age: 80; range: 75 - 86) that completed treatment during this period. All the patients underwent G8q before and after RT. Twelve patients (42.8%) were baseline identified as frail (G8q range 8-14) and 10 of them agreed to underwent a multidimensional geriatric assessment. Five of the 10 patients resulted vulnerable, 5 patients fit for treatment (Table 1). One vulnerable patient refused RT while the remaining were carefully monitored during treatment, according to geriatric prescriptions. All frail patients completed treatment without acute toxicity > grade 2 (RTOG) (Table 2). Overall, only 1 no-frail patient (3.6%) reported acute skin toxicity > grade 3. The G8q at the end of RT did not show a significant deterioration.

According to recent studies, incorporating measurements of frailty in clinical trials is important to reduce the risk of worse outcomes. In our experience, preliminary results confirmed that Geriatric 8 questionnaire represents a simple tool to identify frail patients in daily practice. Although this study is still ongoing, the support of a multidisciplinary approach in vulnerable patients resulted useful in order to obtain their compliance to the treatment without increased toxicity.