ABSTRACT
Breast cancer stands as the prevailing malignancy across all six Gulf Cooperation Council (GCC) nations. In this literature review, we highlighted the incidence and trend of breast cancer in the GCC. Most of the studies reported a consistent increase in breast cancer incidence over the past decades, which was particularly attributed to the adoption of a Westernized lifestyle in the region and the implications of emerging risk factors and other environmental and societal factors, the increase in screening uptake, as well as the improvement in data collection and reporting in the GCC. The data on breast cancer risk factors in the GCC were limited. In this geographic region, breast cancer frequently manifests with distinctive characteristics, including an early onset, typically occurring before the age of 50; an advanced stage at presentation; and a higher pathological grade. Additionally, it often exhibits more aggressive features such as human epidermal growth factor receptor 2 (HER2) positivity or the presence of triple-negative (TN) attributes, particularly among younger patients. Despite the growing body of literature on breast cancer in the GCC, data pertaining to survival rates are, regrettably, meager. Reports on breast cancer survival rates emanating from the GCC region are largely confined to Saudi Arabia and the United Arab Emirates (UAE). In the UAE, predictive modeling reveals 2-year and 5-year survival rates of 97% and 89%, respectively, for the same period under scrutiny. These rates, when compared to Western counterparts such as Australia (89.5%) and Canada (88.2%), fall within the expected range. Conversely, Saudi Arabia reports a notably lower 5-year survival rate, standing at 72%. This disparity in survival rates underscores the need for further research directed toward elucidating risk factors and barriers that hinder early detection and screening. Additionally, there is a pressing need for expanded data reporting on survival outcomes within the GCC. In sum, a more comprehensive and nuanced understanding of breast cancer dynamics in this region is imperative to inform effective strategies for prevention, early detection, and improved patient outcomes.
ABSTRACT
INTRODUCTION: Worldwide statistics highlight that around 40% of breast cancer cases occur in patients aged 65 years and above, with expectations that this will increase as the population gets older. Cancer management in elderly patients is still unclear and depends primarily on individual oncologist decisions. The literature suggests that elderly breast cancer patients receive less intensive chemotherapy than younger patients, which is mainly attributed to a lack of effective individualized assessment or age bias. The current study explored the impact of elderly patient involvement in the decision-making process of breast cancer management and less intensive treatment allocation in Kuwait. METHODS: In an observational exploratory populationbased study, 60 newly diagnosed breast cancer patients aged 60 years and above and candidates for chemotherapy were included. Patients were grouped based on the treating oncologists' decision to receive either intensive first-line chemotherapy (standard treatment) or less intensive/ other than first-line chemotherapy (non-standard treatment) according to standardized international guidelines recommendations. Patients' attitudes toward the recommended treatment (accept/ reject) were documented through a short semi-structured interview. The prevalence of patients' interference with the treatment was reported, and individual causes were investigated. RESULTS: Data showed that 58.8% and 41.2% of elderly patients were allocated for intensive and less intensive treatment, respectively. Overall, 15% of patients interfered with the treatment plan against their oncologists' recommendations even though they were allocated for less intensive treatment. Among those, 6.7% of patients rejected the recommended treatment, 3.3% delayed initiating treatment, and 5% received <3 cycles of chemotherapy but refused to continue cytotoxic treatment. None of the patients requested intensive treatment. This interference was mainly directed by cytotoxic treatment toxicity concerns and targeted treatment preference. CONCLUSION: In clinical practice, oncologists allocate selected breast cancer patients aged 60 years and above for less intensive cytotoxic treatment to enhance their tolerance; however, this was not always associated with patients' acceptance and compliance. Lack of awareness of targeted treatment indications and utilization directed 15% of patients to reject, delay, or refuse to continue the recommended cytotoxic treatment against their oncologists' recommendations.
