The influences of age and co-morbidities on treatment decisions for patients with HER2-positive early breast cancer.
OBJECTIVE
To investigate the influences of age and co-morbidities on the use of adjuvant chemotherapy and trastuzumab in patients with HER2-positive early breast cancer.


METHODS
Thirty surgeons and 101 oncologists reviewed the profiles of 16 hypothetical patients which included details of age, tumour size/grade, nodal/ER status, and co-morbidities. Respondents viewed different patient profiles. Oncologists were asked how likely they would be to prescribe chemotherapy ± trastuzumab. Surgeons were asked whether they would refer to an oncologist.


RESULTS
Oncologists' treatment decisions were most affected by age and co-morbidities: 81% would prescribe chemotherapy for a high-risk patient aged 68 years, but only 47% for an otherwise identical patient aged 73 years. The majority of surgeons (84%) would still refer older patients.


CONCLUSIONS
National variation in the use of adjuvant chemotherapy in women aged ≥70 years with high-risk breast cancer is substantial. Practice audits or clinical trials addressing the outcomes of systemic adjuvant therapy are needed for this ever-increasing population of patients.
Ring
Alistair
A
Sussex Cancer Centre, Royal Sussex County Hospital, Eastern Road, Brighton, East Sussex BN2 5BE, United Kingdom. Alistair.ring@bsuh.nhs.uk
D000367:Age Factors; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D017024:Chemotherapy, Adjuvant / Q000592:standards / Q000706:statistics & numerical data*; D015897:Comorbidity; D003625:Data Collection; D005260:Female; D018734:Genes, erbB-2; D006801:Humans; D008495:Medical Oncology / Q000592:standards / Q000706:statistics & numerical data*; D009367:Neoplasm Staging; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D000068878:Trastuzumab
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D000068878:Trastuzumab