Study Finds Gaps in Support Service Use Among Older Breast Cancer Patients

A new study published in the Journal of Geriatric Oncology highlights a significant gap in the care of older adults with breast cancer: while many face age-related risks that could complicate treatment, a majority decline supportive services even when those risks are identified.

The study, “Preliminary experience supporting older adults with breast cancer: Successes, challenges, and next steps for a program embedded in a breast oncology center,” evaluated the use of geriatric assessments and referrals among breast cancer patients aged 70 and older at a major cancer center from 2022 to 2024. Researchers found that while assessments successfully flagged issues like recent falls, prior hospitalizations, and the need for additional support, only 60% of patients who were referred to geriatric or supportive services actually accepted them.

“We’re identifying patients who are clearly at higher risk for complications from cancer treatment,” said Tammy T. Hshieh, MD, MPH, assistant scientist at the Hinda and Arthur Marcus Institute for Aging Research. “But even when the data shows they would benefit from support, many patients are hesitant to accept help. That disconnect is something the oncology field needs to address.”

Of 362 patients approached, just 108 completed a geriatric assessment. Only 60% of patients who completed the assessment agreed to at least one referral — typically geriatrics (67%) or social work (36%) — despite the fact that 30% had been hospitalized in the prior year, and 19% had experienced a recent fall.

The study was conducted within the Program for Older Adults with Breast Cancer (OABC), part of the Breast Oncology Clinic at the Dana-Farber Cancer Institute. Researchers embedded the geriatric assessment into routine care. Patients who completed the assessment were offered referrals to relevant services based on their responses, such as fall prevention, nutrition, and mental health support.

“Awareness and engagement remain major barriers,” Hsieh added. “Even with dedicated staff explaining the value of supportive care, some patients still associate referrals with weakness or unnecessary intervention. We have work to do in normalizing geriatric and supportive care as a standard part of cancer treatment — especially for older adults.”

The findings reinforce national recommendations that call for routine geriatric assessment in cancer care, especially for older patients who may have complex health profiles that don’t align with typical treatment pathways. Despite strong clinical evidence showing that supportive services improve outcomes, uptake remains limited in busy oncology settings.

Researchers say the next steps include expanding outreach to improve understanding of the geriatric assessment’s purpose, tracking long-term outcomes, and identifying strategies to increase acceptance of support services among high-risk older adults.

In addition to Hshieh, the authors of the study included first author Rachel A. Freedman, MD, MPH, founder and director of the Program for Older Adults with Breast Cancer (OABC) at Dana-Farber Cancer Institute (DFCI); Madeleine Ling, M2, Augusta University Medical Partnership, University of Georgia; Karen Ruderman, MPH, MS, program manager at OABC, DFCI; Sydney Simo, program coordinator at OABC, DFCI; Bonnie McGrath, program coordinator at OABC, DFCI; Craig Snow, MHA, director of breast oncology cohort operations & data management at DFCI; Kathryn Rigby, MSEd, MSW, manager of breast oncology clinical programs, DFCI; Amal Arnaout, PharmD, pharmacy specialist at DFCI; Christina A. Minami, MD, MS, surgeon, Division of Breast Surgery, Department of Surgery, Brigham and Women’s Hospital.

About Hebrew SeniorLife
Hebrew SeniorLife, an affiliate of Harvard Medical School, is a national senior services leader uniquely dedicated to rethinking, researching, and redefining the possibilities of aging. Hebrew SeniorLife cares for more than 4,500 seniors a day across campuses throughout Greater Boston. Locations include: Hebrew Rehabilitation Center-Boston and Hebrew Rehabilitation Center-NewBridge in Dedham; NewBridge on the Charles, Dedham; Orchard Cove, Canton; Simon C. Fireman Community, Randolph; Center Communities of Brookline, Brookline; Jack Satter House, Revere; and Leyland Community, Dorchester. Founded in 1903, Hebrew SeniorLife also conducts influential research into aging at the Hinda and Arthur Marcus Institute for Aging Research, which has a portfolio of more than $98 million, making it one of the largest gerontological research facilities in the U.S. in a clinical setting. It also trains more than 500 geriatric care providers each year. For more information about Hebrew SeniorLife, follow us on our blog, Facebook, Instagram, Threads, and LinkedIn.