Case Western Reserve awarded $0.5M for study of breast cancer in older women

Clinical study to be conducted from University Hospitals Case Medical Center

Cynthia Owusu, MD, associate professor at Case Western Reserve University and geriatric-oncologist at University Hospitals Case Medical Center, the School's primary affiliate, has received nearly $500,000 from Susan G. Komen For the Cure to fund a novel three-year study aimed at improving outcomes for older women with newly-diagnosed breast cancer.

Recent gains in life expectancy coupled with aging as a risk factor for breast cancer makes breast cancer a disease of older women. While breast cancer mortality rates are declining among women less than 70 years of age, they have either remained stable or increased among the oldest women with breast cancer.

"One reason for the existing age-related disparities in breast cancer mortality is the under-treatment of breast cancer among older women in comparison with their younger counterparts," said Dr. Owusu. "Several barriers have contributed to the under-treatment of older women, such as misconceptions and misinformation about reduced functional reserves and tolerability of cancer treatment by older women. This has served to limit their options and impact their survival."

Dr. Owusu hypothesizes that age-related disparities will be observed in receipt of recommended standard treatment for breast cancer and that age-related disparities in breast cancer treatment will be partly explained by differences in declines in physical function that occur during cancer treatment of older women.

To examine the hypothesis requires measurement of physical function and ensuing decline that occurs during breast cancer treatment of older women. The study will enroll 200 women 65 years of age and over who have been newly diagnosed with stage I-III breast cancer.

"Given that current instruments used by medical oncologists to measure physical function among cancer patients have been shown (by clinical research) not to be particularly accurate when applied to senior adults, and none of the instruments currently recommended for screening in senior adults with cancer have been validated for this purpose, there remains a critical need for a well validated instrument for functional decline among senior adults with cancer," continued Dr. Owusu. "Furthermore, despite the existence of substantial literature supporting a strong correlation between several biomarkers and reduced functional reserves, use of such biomarkers to evaluate risk of functional decline and inform the design of interventions for functional decline among senior adults with cancer, remain unexplored."

As a result, Dr. Owusu has proposed to conduct this longitudinal study of 200 women 65 years of age and older who have been newly diagnosed with stage I-III breast cancer recruited from ambulatory surgical and medical oncology clinics of the University Hospitals Case Medical Center and community satellite facilities, in Cleveland, Ohio. Following enrollment, women will be followed prospectively for 12 months to complete study procedures at several time points as follows: at study entry, post-treatment (primary surgery, chemotherapy and radiation therapy), six months and twelve months (study completion).

As a first step, Dr. Owusu will validate an instrument for identifying functional decline in participating patients and then use the instrument to examine the mediating role of functional decline on age-related disparities in breast cancer treatment.

Results from the study will provide new information on the appropriate instrument for measuring functional decline in older women with breast cancer and on the role of functional decline in age-related disparities in breast cancer treatment.

"Understanding this relation is important for designing strategies for remediation of functional decline," said Dr. Owusu. "The ability to correctly identify reduced functional reserves among older women undergoing treatment for breast cancer should be helpful in ensuring that healthy independent older women go on to receive recommended guideline treatment, and those with reduced functional reserve receive the necessary remediation that optimizes their oncology care. Over the long-term, remediation of functional decline among older women with breast cancer should translate into reductions in treatment differences and improved breast cancer survival."

Dr. Owusu is a well-known national leader in the study of breast cancer in older women. She recently made multiple presentations around this important research area during the 2010 American Society of Clinical Oncology (ASCO) meeting.