Psychosocial Determinants and Outcomes of Chemotherapy in Older Women with Breast Cancer

Abstract

With the aging of the U.S. population and rising breast cancer incidence with advancing age, the absolute number of women aged 65 years and older diagnosed with and surviving breast cancer will dramatically increase over the coming decades. Despite this demographic imperative, we know little about the impact of adjuvant therapies in this age group. We synthesized data to describe key findings and gaps in knowledge about the outcomes of adjuvant breast cancer treatment in women aged 65 years and and older ("older women"). We reviewed research published between 1995 and June 2005 on breast cancer outcomes among older women treated with adjuvant therapy for breast cancer. Outcomes included communication, emotional distress, satisfaction, and multiple quality-of-life domains. Only 16 articles focused exclusively on older women and chemotherapy; and only one included a large sample of older women (N = 1755). Most common domains included comorbidities, symptoms, and survival. Of the 13 clinical trials and three observational studies we reviewed, only one clinical trial measured quality of life and psychological factors such as coping. None of the studies examined patient preferences or patient-physician communication (processes of care) in older women. Few studies have been designed to specifically evaluate adjuvant therapy processes and outcomes among older women, especially interactions between treatment and comorbidity, and the impact of the processes of care on outcomes. In addition, only narrow segments of the older population with breast cancer (e.g., well-educated, nonminority women) have been included in trials to date. Thus, at present we do not have sufficient data to assist physicians and their older patients in developing adjuvant treatment decisions and plans tailored to older women's needs, preferences, and concerns.

Perspectives from older adults receiving cancer treatment about the cancer-related information they receive

“…[31] Concerns are frequently raised about the capacity of older adults to tolerate the toxicities associated with treatment and the impact of co-morbid conditions on the final outcomes. [32] The decreasing mobility, diminishing cognitive status, and increasing frailty that can accompany growing older may limit tolerance for treatment, as well as the capacity to cope with the added burdens of cancer. This age cohort may also struggle with poor eyesight, diminished hearing capacity, and issues of literacy.…”

Older women, breast cancer, and social support

“…Advancing age is the single most critical risk factor in the development of breast cancer, and one in ten women over the age of 65 will develop it [1, 47]. Unlike younger breast cancer survivors, older breast cancer survivors face issues of advancing age and more co-morbidities [45] that may result in more side effects from treatment and more complicated recovery [8, 36, 40, 45, 46, 50, 52]. Recent studies have indicated that the toxicity of chemotherapy, such as the side effects of fatigue and nausea, appear more often in older women than in younger women [40].…”

“…Even though there is an increased risk of breast cancer among older women, there is comparatively little literature on the psychosocial impact of a breast cancer diagnosis and its subsequent treatment on older women [50]. What is also known is that older women face under-treatment for cancer in areas including chemotherapy, radiation, palliative care, pain management, and reconstruction [8].…”

Adjuvant chemotherapy in elderly patients with breast cancer: key challenges

“…The literature on this subject is limited -end of life and advanced cancer being more studied settings [49]. Regardless, it is important to note that elderly patients with cancer are willing to undergo treatment and endure significant side effects if it is the price to pay for survival -as long as they feel they are cognitively and physically capable to bare it [50].…”