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Impact of Adjuvant Chemotherapy in Elderly Breast Patients in Taiwan, A Hospital-Based Study

  • Lee, Hsiu Chuan (Department of Internal Medicine, Chi-Mei Medical Center) ;
  • Chen, Wei Yu (Department of Internal Medicine, Chi-Mei Medical Center) ;
  • Huang, Wen Tsung (Department of Surgery, Chi-Mei Medical Center) ;
  • Cheng, Kuo Chen (Department of Internal Medicine, Chi-Mei Medical Center) ;
  • Tian, Yu Feng (Department of Surgery, Chi-Mei Medical Center) ;
  • Ho, Chung Han (Department of Medical Research, Chi-Mei Medical Center) ;
  • Tsao, Chao Jung (Department of Hematology-Oncology, Chi-Mei Medical Center) ;
  • Feng, Yin Hsun (Department of Internal Medicine, Chi-Mei Medical Center)
  • Published : 2016.10.01

Abstract

Purpose: Decisions as to whether to provide adjuvant treatment in older breast cancer patients remains challenging. Side effects of chemotherapy have to be weighed against life expectancy, comorbidities, functional status, and frailty. To aid decision-making, we retrospectively analyzed 110 women with breast cancer treated with a curative intention from 2006 to 2012. Survival data with clinical and pathological parameters were evaluated to address the role of adjuvant chemotherapy in this study population. Method: A total of 110 elderly (>70 years) patients that received mastectomy at two hospitals in Taiwan were observed retrospectively for a medium of 51 months. After mastectomy, patients received conservative treatment or adjuvant chemotherapy, or hormone therapy following clinical guidelines or physician's preference. Data were collected from the cancer registry system. Results: Median age at diagnosis was 75.7 years. Thirty-five percent of patients received adjuvant chemotherapy, these having a significantly younger age ($mean=74.0{\pm}5.3$ vs $77.5{\pm}5.3$, p<0.001) and higher tumor staging (p=0.003) compared with their non-chemotherapy counterparts.Five-year overall survival was non-significantly higher in patients who received adjuvant chemotherapy (with chemotherapy 64.2% vs without chemotherapy 62.6%, p=0.635), while five-year recurrence free survival was non-significantly lower (with chemotherapy 64.1% vs without chemotherapy 90.5%, p=0.80). Conclusions: In this analysis, adjuvant chemotherapy tended to be given to patients with a younger age and higher tumor staging at our institute. It was not associated with any statistically significant improvement in survival and recurrence rate. Until age specific recommendations are available, physicians must use their clinical judgment and assess the tumor biology with the patient's comorbidities to make the best choice. Clinical trials focusing on this critical issue are warranted.

Keywords

Breast cancer;adjuvant chemotherapy;elderly

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