Adjuvant therapy in older patients with breast cancer

Abstract

: Older adults suffer the majority of cancer diagnoses and deaths, and also make up the majority of cancer survivors; however, there is little support in the literature for evidence-based clinical management of older patients with breast cancer. This is to a great extent due to the fact that older adults are commonly excluded from most clinical trials. Thus, an appropriate standard of care for older patients has not been established. Treatment needs to be individualized, taking into account patient health status and preference in addition to the anatomical and biological staging. Employing a comprehensive geriatric assessment (CGA) may be advantageous in older patients. This approach formulates a cancer treatment plan after employing a multidisciplinary approach to evaluate patient vulnerability from several different angles. One aim is to predict adverse events of chemotherapy and identify geriatric problems in advance so that extra support and modified treatment can be provided. As well as overtly adverse events, health-related quality of life (HRQoL) is also important in older patients, due to the negative effects of chemotherapy. For decision making about adjuvant treatment in older patients, we should know that older adults differ from their younger counterparts in terms of willingness to trade survival for current HRQoL. Here, current adjuvant therapies in older patients with breast cancer are reviewed and discussed regarding how to approach decision making.