Lately, our weekly tumor board case reviews have been thought-provoking in that many of our patients brought for discussion are over 85 years of age. There is always great conversation among the specialists about the treatment modalities that can be of benefit to older patients without damaging their quality of life. An article published in the May issue of The Breast Journal discussed this very topic.1
Kaplan and his team wanted to characterize treatment of triple-negative breast cancer (TNBC) in older patients and measure mortality risk relative to younger women. They conducted a retrospective cohort study analysis of patients presenting with primary TNBC, age 25–93, stage I–III from 1990 to 2014, identified and tracked by our registry (n = 771).1
Key elements of their findings:
Of these patients, 80% were < 65 years (n = 612), 13% were 65–74 years (n = 100), and 7% were 75 and older (n = 59).
Older women presented more often with lower-stage breast cancer.
All three age groups were equally likely to have radiation therapy, but older patients were less often treated with adjuvant chemotherapy.
Age alone was not significantly associated with disease-specific mortality.
TNBC survival appears equivalent by age despite less aggressive treatment in patients 75 years and older.1
Patient’s age and abilities within the context of comorbidities are often considered when specialists are planning care for elderly patients.2 However, they are often not included in many research studies or clinical trials.
Most journal articles I have reviewed state future research should include older women as this population is increasing and likely to have a cancer diagnosis later in life. Peak recurrence generally occurs 3 years post-treatment.3 What would the treatment plan be in a woman now 3 years older from the initial diagnosis? What would her life expectancy be with second-line treatment? These are questions that yet to be answered. As the population ages, it would be a suitable research project.
Has anyone else noted an increase in older women with TNBC? What are the guidelines being used for your population of patients?
Kaplan HD, Malmgren JA, Mary K. Atwood MK. Triple-negative breast cancer in the elderly: Prognosis and treatment. Breast J. 2017 May 9.
Hamelinck VC, Stiggelbout AM, van de Velde CJH, et al. Treatment recommendations for older women with breast cancer: A survey among surgical, radiation and medical oncologists. Eur J Surg Oncol. 2017 Jul;43(7):1288-1296.
Kumar P, Aggarwal R. An overview of triple-negative breast cancer. Arch Gynecol Obstet. 2016 Feb;293(2):247-69.
Male breast cancer accounts for about 1% of all breast cancer cases in the United States, therefore it can be a shocking diagnosis. During my career as a nurse practitioner in the field of breast oncology, I have been involved in the care of only five male breast cancer cases over the last 25 years.
FDA Approves Onivyde for Advanced Pancreatic Cancer Marijke Vroomen Durning, RN, 10/27/2015 3 On October 22, 2015, the US Food and Drug Administration (FDA) approved Onivyde (irinotecan liposome injection, Merrimack Pharmaceuticals, Inc.), in combination with fluorouracil ...