Breast cancer is the most common cancer among women in the US, affecting one in three female cancers, and is the second leading cause of cancer death. In one pivotal study of clinical trial participation, only 9% of trial participants aged 75 years plus compared to 31% of the overall patient population.
For this review, we searched for relevant articles in PubMed and Embase through October 2015. In one recent study of 984 older patients considered functionally normal by Karnofsky performance status, almost 70% had one primary deficit identified by the geriatric assessment. Nearly 20% had two shortfalls that could affect treatment tolerance outcomes.
Around 75% of patients aged 80 years and older reflect HR-positive and HER2-negative tumours, whereas more aggressive triple-negative and HER2-positive lesions account for the remainder.
Patients aged 80 years plus usually undergo surgery well, with low complication rates. In a study of 120 women aged 80 years plus, 32% had a simple mastectomy, 27% breast conservation, and 6% axillary dissection, major complications involved wound healing were just 6%.
Metastatic breast cancer remains incurable, regardless of age. In conclusion, patients with breast cancer who are age 80 years and older represent a unique and expanding part of the population. Treatment decisions should focus on life expectancy, the potential benefits; the patient’s goals; and the potential risks, including effects on function and quality of life. Clinical trials that focus on the old age group are a must.
Ref: https://ascopubs.org/doi/full/10.1200/JOP.2015.010207
