A Joint Geriatric Oncology Breast Cancer Clinic for Older Women: A Two-Year Sequential Service Evaluation

Background 

Breast cancer is the most common cancer diagnosed among women in the UK. The incidence increases with age: older women with breast cancer represent a clinically complex population with more advanced disease. High rates of frailty, multimorbidity and underrepresentation in clinical trials contribute to variation in care. This service evaluation describes a novel joint geriatric oncology breast cancer clinic and reports its clinical activity, patient characteristics and outcomes over two sequential years. 

Method

A two-year service evaluation was conducted at the Joint Geriatric Oncology Breast Cancer Clinic, University Hospitals Sussex NHS Foundation Trust, Brighton. Patients aged ≥ 65 with a confirmed breast cancer diagnosis reviewed between October 2022 and December 2024 were included. Data were extracted using structured collection forms in two phases: Phase 1 (2022-2023, n=68) and Phase 2 (2023-2024, n=61). Descriptive statistics were used to analyse data including patient demographics, use of the Comprehensive Geriatric Assessment (CGA) model, tumour characteristics and treatment decisions. 

Results

A total of 197 appointments involving 129 patients (mean age 86 years;99.2% female) were analysed. Non-attendance occurred in 21.8% of appointments, representing an important consideration in service delivery. Across both phases, patients had a mean of 5.05 comorbidities and had a mean of 7.45 medications. The mean Clinical Frailty Scale score was 5.35.  The majority of tumours were ER-positive (>93% across both phases) and most patients were managed with primary endocrine therapy (PET). In Phase 2, six patients (9.8%) were referred for surgery, compared with 21.6% in a 2017 cohort study for the same clinic. All patients referred for adjuvant radiotherapy completed their course. 

Conclusion

This joint clinic model supports multidisciplinary, geriatric-informed breast cancer care for older women and identifies patients who remain candidates for surgery. Holistic geriatric assessment supports individualised, shared decision-making in an underrepresented population. Non-attendance should inform future service planning.