Optimising the care of primary breast cancer in older women—potential for a dedicated service

The management of elderly patients with breast cancer is complex. Currently, most of their treatment guidelines have been adapted from studies conducted in younger patients. However, studies have shown that breast cancer in the elderly have distinctive biological characteristics from the young. Also, older patients have different needs from younger patients—including increased frailty, decreased functional status, comorbidities, polypharmacy, cognition, psychosocial support and nutrition. These should be assessed appropriately to take into account their daily function and quality of life. A comprehensive geriatric assessment could help identify pre-treatment risk factors and could guide clinical decision making, improving morbidity and prognosis. We describe a potential set up for a dedicated multidisciplinary-led elderly breast cancer clinic to provide the assessment, review and management of this distinctive set of patients.