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Older Women With Breast Cancer Missing Out on Chemo

Many not being offered lifesaving treatment because of their age, researcher says

TUESDAY, March 1, 2005 (HealthDay News) -- Scientists say they have found evidence of age bias in the treatment of breast cancer.

Specifically, older patients are not being offered chemotherapy as often as younger ones are, even though a survey of trials showed that both groups generally did equally well on that regimen.

"The message, at least for healthy older women, is if you're considering chemotherapy and you feel that that's appropriate, then it would be perfectly reasonable to give it," said Dr. Hyman Muss, lead author of a study appearing in the March 2 issue of the Journal of the American Medical Association. Muss is professor of medicine at the University of Vermont and Vermont Cancer Center in Burlington.

"This is very elegant work that shows us that we shouldn't prejudice our decisions based on someone's chronologic age," said Dr. Jay Brooks, chairman of hematology/oncology at the Ochsner Clinic Foundation in New Orleans. "We need to look at the individual."

About half of all new breast cancers in the United States are diagnosed in women 65 years or older. Older women also tend to have a higher risk of cancer recurrence, for which chemotherapy is considered effective. Yet, these are the very women who are frequently not offered this type of treatment.

"There's a public, emotional view that chemotherapy is bad. Your hair falls out. You get sick to your stomach. You have low blood counts. You can die from the side effects of chemo," Muss said. "It's all true, but we're treating breast cancer, which is a disaster. Chemotherapy unquestionably can improve your chances of surviving breast cancer."

"People look, and they see a little old lady and say, 'I can't give them chemotherapy, that's a horrible thing,' But, in fact, it's not," added Dr. Avi Barbasch, an associate clinical professor of medical oncology at Mount Sinai School of Medicine in New York City. "If they're healthy and well otherwise, they can tolerate the treatment quite nicely. We've known that for a long time."

Muss and his colleagues analyzed data involving almost 6,500 women enrolled in four randomized trials between 1975 and 1999. The trials compared less aggressive chemo with more aggressive chemo. Eight percent of the participants were 65 years and older, while 2 percent were 70 or older.

Overall, women with smaller tumors, fewer positive lymph nodes, more chemotherapy and tamoxifen therapy survived longer. There appeared to be no association between age and disease-free survival. However, older women were more likely to die of complications related to treatment (1.5 percent) vs. younger women (0.2 to 0.7 percent).

"It's the best therapy available for breast cancer, even though it has a little bit more toxicity," Muss said. "It's not a surprising finding, but it was nice to see it work out."

Despite its benefits, chemo is clearly not for everyone in the older age group. Those who are frail or have other medical conditions probably would not be good candidates for treatment.

Better candidates would be older women in generally good health with hormone receptor-positive breast cancer, positive lymph nodes, a high risk of recurrence and a life expectancy of more than five years.

According to an accompanying editorial in the journal, healthy women aged 65, 75 and 85 can expect to live an additional 20, 12 and 6 years, respectively.

The findings also present an argument for including more older women in trials. Currently, the older age group is vastly underrepresented.

It might make sense to shoot for 20 percent to 25 percent of trial participants to be aged 65 or over, Muss said.

"It would probably be a disaster if it was an equal balance because it might mean an 85-year-old women being put on intensive therapy, which is probably not a great idea," he added.

In real-life treatment, Muss said, "there needs to be a better balance. If you're 68, it doesn't mean you shouldn't be considered for the best-quality treatment if you're in otherwise good health. If doctors don't bring it up, patients don't get a chance to do it."

More information

Adjuvant Online can help physicians and patients discuss the pros and cons of additional treatment for breast cancer.

SOURCES: Hyman B. Muss, M.D., professor, medicine, University of Vermont and Vermont Cancer Center, Burlington, Vermont; Jay Brooks, M.D., chairman, hematology/oncology, Ochsner Clinic Foundation, New Orleans; Avi Barbasch, M.D., associate clinical professor, medical oncology, Mount Sinai School of Medicine, New York City; March 2, 2005, Journal of the American Medical Association
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