title: Perspectives and attitudes on the use of adjuvant chemotherapy and trastuzumab in older adults with HER-2+ breast cancer: a survey of oncologists.
abstract: BACKGROUND
  Substantial evidence supports the use of adjuvant trastuzumab with chemotherapy for patients with human epidermal growth factor receptor (HER)-2(+) breast cancer; however, a lesser amount of data is available to guide use of this therapy in older patients and in those with significant medical comorbidities. The goal of the current study was to understand how patient age and health status impact oncologists' decisions to recommend adjuvant therapy in older women with HER-2(+) breast cancer.
  
  
  METHODS
  Medical oncologists (n = 151) participated in an online survey regarding treatment recommendations for a hypothetical patient of varying age and health status with tumor stage 2, nodal stage 2, estrogen receptor-negative, HER-2(+) breast cancer. Survey respondents recommended either chemotherapy plus trastuzumab, chemotherapy alone, trastuzumab alone, or no therapy. The effect of age and health status on therapeutic recommendations was assessed.
  
  
  RESULTS
  As the hypothetical patient's age increased or health status deteriorated, oncologists were less likely to recommend a combination of chemotherapy plus trastuzumab. In contrast, oncologists were more likely to recommend either trastuzumab alone or no therapy for patients with advanced age and deteriorating health status. Chemotherapy alone was recommended by only 7.5% of respondents, on average.
  
  
  CONCLUSIONS
  With limited evidence-based data for the treatment of older women with early-stage HER-2(+) breast cancer, medical oncologists recommend a diverse array of therapeutic approaches. With increasing age and declining health status they were less likely to recommend chemotherapy plus trastuzumab and more likely to recommend single-agent trastuzumab or no therapy.
authors.affiliation: City of Hope, Duarte, California 91010, USA. ahurria@coh.org
authors.forename: Arti
authors.initials: A
authors.lastname: Hurria
authors.forename: F Lennie
authors.initials: FL
authors.lastname: Wong
authors.forename: Sumanta
authors.initials: S
authors.lastname: Pal
authors.forename: Cathie T
authors.initials: CT
authors.lastname: Chung
authors.forename: Smita
authors.initials: S
authors.lastname: Bhatia
authors.forename: Joanne
authors.initials: J
authors.lastname: Mortimer
authors.forename: George
authors.initials: G
authors.lastname: Somlo
authors.forename: Sara
authors.initials: S
authors.lastname: Hurvitz
authors.forename: Doojduen
authors.initials: D
authors.lastname: Villaluna
authors.forename: Arash
authors.initials: A
authors.lastname: Naeim
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000378:metabolism; D017024:Chemotherapy, Adjuvant; D003657:Decision Making; D005260:Female; D019538:Health Care Surveys; D006304:Health Status; D006801:Humans; D008297:Male; D008495:Medical Oncology / Q000706:statistics & numerical data*; D008875:Middle Aged; D009367:Neoplasm Staging; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D018570:Risk Assessment; D000068878:Trastuzumab; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D000068878:Trastuzumab