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

To assess adjuvant chemotherapy recommendations, administration and disease-specific survival for invasive breast cancer (BC) among patients 75years and older compared with that of younger women.

A 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).

Seventy-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 65-74year olds, but significantly worse in stage II and III patients, respectively (stage II 5year DSS 90% vs. 97%, stage III 5year DSS 65% vs. 81%).

Patients 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.