Chemotherapy of Breast Cancer in the Elderly

Abstract

Breast cancer arises in about 48% of patients older than 65 years and more than 30% occurs in those over 70 years being the leading cause of cancer-related death in women older than 65. Elderly patients tolerate chemotherapy poorly compared to their younger counterpart because of progressive reduction of organ function and comorbidities related to age. For this reason, the elderly have been excluded from or underrepresented in most cancer studies and, in clinical practice, they often receive inadequate and untested treatments. For adjuvant chemotherapy, a low percentage of patients over 70 years of age were included in few trials and always in a proportion much lower than the prevalence of cancer in that age group. Adjuvant chemotherapy, preferably including an anthracycline especially in patients with HER-2/neu-positive tumours, seems to be beneficial in older women who have substantial risk of dying of breast cancer. To date even if there is no specifically randomised study, single-agent chemotherapy probably might be considered a reasonable treatment for advanced breast cancer in the elderly. One of the actual main field of clinical research in the treatment of breast cancer is the role of targeted therapies. Chronologic age is a risk factor for toxicities such as myelosuppression and mucositis, and older patients may require more supportive care. In order to plan medical treatment in breast cancer elderly patients is mandatory to practice a comprehensive geriatric assessment that includes evaluation of comorbidities, functional dependence, socio-economic, emotional and cognitive conditions, an estimate of life expectancy and recognition of frailty. The authors review the literature regarding age-specific chemotherapeutic issues in the management of breast cancer elderly patients.

The influence of demographics, psychological factors and self-efficacy on symptom distress in colorectal cancer patients undergoing post-surgical adjuvant chemotherapy

“…Qian and Yuan reported a significant negative relationship between age and self-efficacy (Qian and Yuan, 2012). Compared to younger adults, older adults are at greater risk of developing certain complications related to chemotherapy, resulting in unpleasant and serious side effects, and older patients, in particular, have lower tolerance for the toxicity of chemotherapy (Rossi et al, 2005;Gaddipati et al, 2011;Genc and Tan, 2011). Beckham et al found that age was significantly related to patients' ability to adjust to having cancer, and that younger patients adjusted better to having cancer, which may have been related to greater expectations about control over cancer-related symptoms (Beckham et al, 1997).…”

Amelioration of Doxorubicin-Induced Cardiotoxicity by an Anticancer-Antioxidant Dual-Function Compound, HO-3867

“…Resistance to chemotherapy is a commonly encountered impediment in the treatment of breast cancer (Pivot et al, 2000;Rossi et al, 2005). Such resistance can prove to be a major limitation to the effectiveness of the treatment, neces- sitating the use of increased doses, which can lead to debilitating consequences that substantially reduce the quality of life of patients.…”

New Criteria for Selecting Elderly Patients for Breast Cancer Adjuvant Treatment Studies

“…For adjuvant chemotherapy, low percentages of patients Ͼ70 years of age were included in few trials, and always in a proportion much lower than the prevalence of cancer in that age group [26]. Whereas one half of breast cancers occur in patients Ͼ65 years old and one fourth occur in patients Ͼ75 years old, only 17% and 3%, respectively, of patients included in cooperative trials were in these age ranges [27].…”