Patterns of Adjuvant Treatment and Compliance with the Guidelines in Elderly Patients with Cancer Breast Single Institution Experience
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Patterns of Adjuvant Treatment and Compliance with the Guidelines in Elderly Patients with Cancer Breast Single Institution Experience,AZZA M. ADEL and EMAN T. EL-SHEIKH
Abstract
Background: There is lack of practical guidelines of the adjuvant treatment in elderly patients with breast cancer. Therefore we performed this retrospective analysis of the actual use of adjuvant treatment (chemotherapy, hormonal treatment, and postoperative radiotherapy) as well as extent of surgical intervention in women 60 years or older.
Patients and Methods: Patients with non metastatic breast cancer older than or equal to 60 years of age, treated in the period from April 2006 to December 2009 at Clinical Oncology Department, Ain-Sham University Hospitals, were included in this study. Patients were divided into 2 groups: (Group I) which included patients 60-69 years old were compared to patients >!70 years (Group II). Patient characteristics, clinico-pathologic factors, primary and adjuvant treatment received were analyzed.
Results: A total of 152 patients were studied, 92 patients in group I compared to 60 patients in group II. Older patients had more co-morbid conditions (21.7% Vs. 46.7% for groups I and II respectively, p=0.03), poor performance status ECOG 2 in 19.6% Vs. 45% for groups I and II respectively (p=0.001), tumor size >5cm in 39.1% Vs. 60% of groups I and II respec-tively (p=0.01). Older patients had a more favorable tumor characteristics as tumor grade III was found in 17.4% Vs. 6.7% (p=0.05) and ER + in 34% Vs 56% (p=0.01) of groups I and II patients respectively. Older patients presented after a relatively longer period of time from surgery than younger patients (mean time 20.7 days Vs. 27.31 days for groups I and II respectively (p=0.39). There were no significant differ-ences between the two groups regarding, lymph node me-tastases, or Her2/neu status. More patients in group I underwent conservative surgery than group II patients (23.9% Vs. 13.3% for both groups respectively). Non-adherence to guidelines on chemotherapy was present more in group II patients as 9 patients in this group (15%) were offered primary endocrine therapy although chemotherapy was clearly indicated (N + disease, tumors >5cm, and grade III tumors) compared to none of the patients in group I. The causes of this non-adherence to guidelines were: Patient preference (3 patients, 5%) and the presence of co-morbid conditions (6 patients, 10%). Anthracycline based chemotherapy was prescribed more frequently to younger patients (86.96% compared to 16.67% for both groups respectively, (p=0.001). Regarding adjuvant radiotherapy, group II patients were also less com-pliant to the guidelines as radiotherapy was omitted from the course of treatment in 10 patients (16.7%) compared to none of the patients in group I (p=0.001). Grade 3/4 hematologic toxicity was higher in the older age group 21.6% Vs. 31.3% for groups I and II respectively. The 2-years overall survival rates were 94.6% and 81.6 % for groups I and II respectively (p=0.001), while disease free rates were 91.3% and 76.6% in groups I and II respectively (p=0.04).
Conclusion: This study showed that guidelines are less strictly followed in patients over the age of 70 due to several reasons such as co-morbid conditions, patient compliance, and bias regarding chronologic age of the patient. Thus, the development of a safer and more efficacious treatment strategy is urgently needed for this group of patients.