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Chemotherapy has traditionally not been recommended for older women -- roughly those over 65 or 70 -- after breast cancer surgery.
"Historically, there have been some biases against older women in terms of, could they tolerate the (chemotherapy) treatment, and whether they would benefit from it," says Dr. Arash Naeim, assistant professor of medicine at the University of California, Los Angeles' David Geffen School of Medicine.
The bias did have a rationale, however. "The number of women over age 70 in clinical trials (testing chemotherapy regimens) is limited. And so it is difficult to draw inferences," adds Naeim, who's also director of the geriatric oncology program at the Jonsson Comprehensive Cancer Center in Los Angeles.
About half of all new breast cancers in the United States are diagnosed in women 65 years or older. Older women are also at higher risk of cancer recurrence, for which chemotherapy is considered an effective treatment. Yet these are the very women who are frequently not offered this type of therapy.
But some recent studies have begun to suggest that chemotherapy should be considered for older women with breast cancer.
One, led by Dr. Hyman Muss, a professor of medicine at the University of Vermont and Vermont Cancer Center in Burlington, concluded that age alone should not be a reason to rule out chemotherapy in older women who are in good general health.
In the study, which appeared in the March 2, 2005, issue of The Journal of the American Medical Association, Muss and his colleagues analyzed data on nearly 6,500 women who took part in clinical trials between 1975 and 1999.
The researchers compared less aggressive chemotherapy with more aggressive treatments. Eight percent of the women were 65 and older, and 2 percent were age 70 and above.
The researchers found no association between age and disease-free survival. They did find that overall survival was worse for those women age 65 and older, but that was due to death from causes other than breast cancer.
Also, older women were more likely to die of complications related to chemotherapy treatment (1.5 percent) versus younger women (0.2 to 0.7 percent). But older and younger women derived similar decreases in death rates from breast cancer, and in recurrence, when they were on the regimens containing the more aggressive chemotherapy, the study found.
"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," Muss told HealthDay.
No one is saying it's best to offer all older women chemotherapy, Naeim emphasizes. "It's a very complicated process, the pathway to the treatment decision," he says. "There is no right answer to whether chemotherapy is the right or the wrong treatment."
Naeim, who has also published on the topic, says it's important to take the total patient into account when deciding whether to recommend chemotherapy.
"Take an older woman with arthritis, in a wheelchair, with coexisting disease (such as heart problems), who just had surgery for breast cancer," he says. "The doctor is saying he can give you chemo, and this may help you not get breast cancer down the road. That person may not be interested in down the road.
"Their baseline quality of life may not be so good, Naeim says.
"And having a worse quality of life (during chemotherapy) is not worth it for them, perhaps. It's easy (for the doctor) to say something improves your survival or quality of life, but it might be that the amount it improves it is so small you may decide it is not worth doing it."
For older women with breast cancer facing treatment decisions, Naeim offers this advice: "Understand the goals and objectives of the treatment. Patients often don't understand why they are getting (a specific treatment), the purpose of the treatment."
It's wise to ask.
"Ask for alternatives," Naeim says. "There is no one right answer, and there are multiple options."
Making such decisions should be easier for older women in the future, he says. "There are more and more researchers actively looking at the older population, and the more studies that come out that focus on that, the more information we will have to make rational decisions."
(The HealthDay Web site is at http://www.HealthDay.com.)
c.2006 HealthDay News
