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Older Breast Cancer Patients Less Likely to Get Chemo

Researchers say age was the only factor for who got treatments

(HealthDay is the new name for HealthScoutNews.)

WEDNESDAY, Aug. 13, 2003 (HealthDayNews) -- Women over 65 who were operated on for breast cancer were less likely to receive chemotherapy following their surgery than women under 50.

That's the finding of a new study of 480 women by researchers at Ohio State University Medical Center.

After taking into account the stage of the women's illness, tumor size, lymph node involvement, and type of breast cancer involved, the researchers found older age was the only difference between those who received chemotherapy after surgery and those who didn't.

"Our theory was that we'd find that when you control for all the factors that influence chemotherapy after surgery, that age would not be a factor," says study author Dr. Charles L. Shapiro, director of the Breast Medical Center at Ohio State. "But the opposite was true -- age was more of a factor."

The results of the study appear in the Sept. 15 issue of Cancer, and were published this week on the journal's Web site.

The researchers note that chemotherapy often isn't as effective for older women, and the risks can be greater.

"Chemotherapy following breast cancer surgery is fairly standard for younger women," Shapiro explains, "but older women get it less because the benefits are not as great, and there is a perception that older women won't tolerate the medication."

However, he says, while the benefits are less for older women, "they're not zero." And considering that women are living longer and healthier lives, they might be amenable to adjuvant therapy -- the term for therapy after surgery -- knowing it reduces the risk for recurrence of breast cancer, Shapiro says.

"Chemotherapy is not devoid of benefit, but there is a possibility that the doctor, when conferring with the [older] patient, doesn't offer or discuss the treatment because of a judgment that it doesn't work or that it is too toxic," Shapiro says.

Whether doctors are discussing adjuvant therapy with older women "merits investigation," he says.

Dr. Jay Brooks, chief of hematology and oncology at the Ochsner Clinic Foundation in New Orleans, says it's more likely it's the older women who are deciding against chemotherapy.

"Rather than age bias, it may well be that individuals choose to do this," he says. "Individuals make decisions at different stages of their lives. A lot has to do with a person's perception, thinking it's not worth it."

Among his own breast cancer patients, Brooks says, 80 percent of women under 50 have adjuvant chemotherapy, compared to 75 percent of women between 50 and 65, and 50 percent of women over 65.

Among the factors that discourage older women from having adjuvant therapy, Brooks says, are other medical conditions they might have, such as congestive heart failure. Or the patient may do her own risk/benefit analysis, weighing the benefits of the treatment against the problems chemotherapy can cause, including hair loss, a 10 percent infection rate and nausea.

Then there's the reality of an older woman's life span.

"Among 80-year-olds, 50 percent will be dead in the next 10 years," he says.

In the study, Shapiro and his colleagues reviewed the cases of 480 women with localized, non-metastatic breast cancer, dividing them into three age groups: under 50, 50 to 65 and over 65. They also divided the women by the type of breast cancer. There are two main types of breast cancer. One is estrogen receptor (ER) positive cancer, which is treated with hormonal therapy and, in some cases, chemotherapy after surgery. There's also estrogen receptor (ER) negative breast cancer, for which chemotherapy is the only treatment after surgery.

Of the women with ER negative breast cancer, women over 65 were seven times less likely to receive adjuvant therapy than were women under 65. The women over age 65 with ER positive cancer were 62 times less likely to receive the adjuvant therapy than those women under 50.

The study spells out the known risks of adjuvant therapy for older women that might outweigh the benefits of treatment. These include the fact that the effects of chemotherapy decline with increasing age, and the toxicity of the therapy may increase in older women. And for some women, the risk of death from other illnesses they may have is higher than the risk of death from breast cancer, the researchers say.

"But a large portion of patients are physiologically healthy even though they are chronologically old," Shapiro says. "And, relatively speaking, the population of people over 65 is increasing, so this [study] serves to illuminate the difficulty of decisions of chemotherapy treatment in the elderly and to get physicians to think about this issue."

More information

A thorough explanation of adjuvant therapy can be found at the National Cancer Institute. A fact sheet about other types of treatments for breast cancer is available from the American Academy of Family Physicians.

SOURCES: Charles L. Shapiro, M.D., associate professor, medicine, and director, Breast Medical Center, Ohio State University Medical Center, Columbus; Jay Brooks, M.D., chief, hematology/oncology, Ochsner Clinic Foundation, New Orleans; Sept. 15, 2003, Cancer, available online Aug. 11, 2003
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