Treatment patterns of elderly breast cancer patients at two Canadian cancer centres.
BACKGROUND
Treatment of breast cancer in elderly women is limited by declining functional status and life expectancy. The impact of providing less aggressive treatment remains controversial. This study assessed the treatment patterns of elderly breast cancer patients.


METHODS
Retrospective chart review of women ≥70 y with breast cancer treated between 2004 and 2011 at two large Canadian cancer centres. Tumour and treatment characteristics were collected across three subgroups: 70-74 y (n = 314), 75-79 y (n = 233), and ≥80 y (n = 219). Comparisons were made using Chi-squared test, Fisher-Freeman-Halton exact test, or ANOVA. Disease free (DFS) and overall (OS) survival were estimated by Kaplan-Meier analysis and compared by log-rank test.


RESULTS
Women ≥80 y had larger tumours that were better differentiated, hormone receptor-positive, HER2-negative, and lymph node (LN)-positive relative to younger women (p < 0.05). Women ≥80 y more frequently underwent mastectomy than breast conserving surgery and lacked LN staging (p < 0.05). Chemotherapy was provided in few patients, especially ≥80 y. Radiation therapy was provided less often in women ≥80 y despite indications. Hormone therapy was more frequently provided in women ≥80 y. Women ≥80 y had a significantly lower DFS (17.5 m) relative to women 70-74 y (31 m, p = 0.02) and 75-79 y (35 m, p = 0.006). Women ≥80 y had the lowest median OS (53 m) relative to 70-74 y (79 m, p = 0.001) and 75-79 y (75 m, p = 0.003) women.


CONCLUSIONS
Women ≥80 y received less aggressive treatment than younger women and had less favourable DFS and OS. Until age-specific recommendations are available physicians must use clinical judgement and assess the tumour biology with the patient's comorbidties to make the best choice.
Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON M5N 3M5, Canada. Electronic address: fernando.angarita@mail.utoronto.ca.
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Angarita
Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON M5N 3M5, Canada. Electronic address: tyler.chesney@gmail.com.
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Chesney
Department of Medical Oncology, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada. Electronic address: Christine.Elser@uhn.ca.
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Elser
Laboratory Medicine Program, Toronto General Hospital, University Health Network, Toronto, ON M5G 2C4, Canada. Electronic address: AnnaMarie.Mulligan@uhn.ca.
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Mulligan
Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON M5N 3M5, Canada; Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5T 2M9, Canada. Electronic address: David.McCready@uhn.ca.
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McCready
Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON M5N 3M5, Canada; Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5T 2M9, Canada; Marvelle Koffler Breast Centre, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada. Electronic address: JEscallon@mtsinai.on.ca.
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Escallon
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D002170:Canada; D002173:Cancer Care Facilities; D018270:Carcinoma, Ductal, Breast / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D018275:Carcinoma, Lobular / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000706:statistics & numerical data*; D008408:Mastectomy / Q000706:statistics & numerical data*; D015412:Mastectomy, Segmental / Q000706:statistics & numerical data; D009367:Neoplasm Staging; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D011980:Receptors, Progesterone / Q000378:metabolism; D012189:Retrospective Studies; D047368:Tumor Burden
D000970:Antineoplastic Agents; D018931:Antineoplastic Agents, Hormonal; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; C508053:ERBB2 protein, human
Adjuvant therapy; Aged; Breast neoplasm; Neoadjuvant therapy; Treatment outcomes