Care of the older woman with primary breast cancer: a sign of the times?

Abstract

POROCK D., CHEUNG, K.L., MORGAN D.A.L., WINTERBOTTOM L., RICHARDSON H. & ELLIS I.O. (2009) European Journal of Cancer Care18, 527–529 Care of the older woman with primary breast cancer: a sign of the times?

Continuing disparities in survival rates between younger and older cancer patients in Europe. Might oral chemotherapy provide one solution to the problem?

“…In parallel with this, it would appear that elderly colorectal cancer patients over the age of 70 continue to be under‐treated, and are also under‐represented in clinical drug trials in spite of the fact that their exclusion from such research is unwarranted (Rougier et al., 2004). Similar attitudes have been demonstrated by medical oncologists and radiotherapists in respect of elderly breast cancer patients (Protière et al., 2009; Hershman et al., 2008) so that their management is sometimes sub‐optimal and predicated on clinical trials carried out on younger patients whose responses to specific treatment dosages may be very different (Ershler, 2006; Porock et al., 2009).…”

“…The authors suggest in relation to breast cancer, that older women are likely to present themselves belatedly with larger tumours and disease positive lymph nodes, but are less likely to be offered adjuvant therapy than younger women, even after adjusting for comorbidities or other age‐related treatment considerations so that they subsequently receive ‘non‐standard management’ (Lavelle et al., 2007). It would seem therefore, that advances in the management of breast cancer amongst younger women are not being replicated in older cohorts (Porock et al., 2009), a small gap in survival rates between the two age groups observed prior to the development of many treatment advances in the 1980s and 1990s becoming more pronounced in the later period covered by Quaglia et al. 's analysis (1997 to 1999).…”

Chemotherapy treatment decision making by professionals and older patients with cancer: a narrative review of the literature

“…More clinical trials are now widening the inclusion criteria, but there remains a paucity of evidence about the most appropriate chemotherapy regimens to offer older patients (O'Connor 2011). Porock et al . (2009) argue that both psychosocial and biological factors are so different in older women with breast cancer that specific studies in the older population are essential, and the argument can be extended to all other tumour types.…”

“…More clinical trials are now widening the inclusion criteria, but there remains a paucity of evidence about the most appropriate chemotherapy regimens to offer older patients (O'Connor 2011). Porock et al (2009) argue that both psychosocial and biological factors are so different in older women with breast cancer that specific studies in the older population are essential, and the argument can be extended to all other tumour types. Mitry and Rougier (2008) reviewed the available evidence of the benefit of chemotherapy in older patients with metastatic colorectal cancer and concluded that regimens used with younger patients gave similar advantages in overall survival and progression free survival, although dose reductions may be required to avoid or reduce severe toxicities.…”

Living with Cancer Aged 75 and Older: A Biographical Narrative Case-Study

“…In the United Kingdom, Department of Health cancer publications since 2000 focus predominantly on the under 75s (Department of Health, 2000, 2005. Moreover there has been continuing concern that older people's specific needs, both physical and psychosocial, are not sufficiently considered, independently of their chronological age, when prescribing treatment and care for cancer (Bailey et al, 2003;Kagan, 2008;National Cancer Intelligence Network, 2013;Porock et al, 2009).…”