Adjuvant chemotherapy and differential invasive breast cancer specific survival in elderly women

ObjectiveTo assess adjuvant chemotherapy recommendations, administration and disease-specific survival for invasive breast cancer (BC) among patients 75 years and older compared with that of younger women.Materials and MethodsA cohort of patients with primary breast cancer, aged 65–94, stages I–III from 1990 to 2010 was identified and tracked by our breast cancer registry (n = 2329). Stage, treatment recommendations and outcomes were chart abstracted at diagnosis and follow-up. Associations were tested with logistic regression and the Kaplan–Meier method was used for disease-specific survival (DSS).ResultsSeventy-five percent of patients aged 75 + were seen by an oncologist compared with 78% aged 70–74 and 84% aged 65–69. Women aged 75 + seen by an oncologist were more likely age 75–79, stage II/III, hormone receptor negative (HR −) or her-2/neu positive. Of these patients, age, stage and HR status were related to a chemotherapy recommendation. Of 106 patients recommended for chemotherapy, 18 refused (17%) and 24 did not complete treatment due to complications, patient choice, disease progression or death not related to treatment. DSS was equivalent for patients 75 and older with stage I BC compared to 65–74 year olds, but significantly worse in stage II and III patients, respectively (stage II 5 year DSS 90% vs. 97%, stage III 5 year DSS 65% vs. 81%).ConclusionPatients aged 75 and older with invasive breast cancer who were recommended for adjuvant chemotherapy have a high rate of refusal and complications from therapy. Their disease specific mortality disadvantage is restricted to stage II and III patients, a group in need of effective therapy to improve disease survival.