title: Adjuvant chemotherapy in elderly patients with primary breast cancer: are women ≥65 undertreated?
abstract: OBJECTIVE
  To establish whether women over 65 years of age with newly diagnosed with breast cancer (BC) receive adjuvant chemotherapy less frequently than younger postmenopausal women and whether comorbidity influences this potential undertreatment.
  
  
  METHODS
  In a single-site, retrospective, comparative study, postmenopausal early stage BC patients treated between 01/2001 and 12/2005 at a major German university hospital were analyzed in two age Groups A and B (≥65 vs. <65 years) for initiation and completion of guideline-recommended adjuvant chemotherapy. Risk stratification was based on the 2005 St. Gallen Consensus Conference criteria. Comorbidity was parametrized using the Charlson Comorbidity Index (CCI).
  
  
  RESULTS
  Analysis included 634 patients, 380 in Group A and 254 in Group B. Mean age (range) was 73 (65-94) and 61 (55-64) years, respectively. The proportion of patients from Group A given ≥3 cycles of chemotherapy was significantly decreased as compared to Group B. 52 % of patients with CCI <3 but only 20 % with CCI ≥3 were recommended to undergo chemotherapy (p < 0.001). Median follow-up [95 % confidence interval (CI)] was 85 (82-88) months. DFS was significantly shorter in patients aged ≥65 years as compared to younger postmenopausal patients (HR, 0.598; 95 % CI, 0.358-0.963; p = 0.048).
  
  
  CONCLUSIONS
  Despite being high-risk patients, older women with early stage BC were often not given guideline-recommended chemotherapy. Higher recurrence rates compared with younger postmenopausal women suggest that older patients are undertreated. Treatment needs to be adapted to general health and tumor biology rather than age. More trials in elderly BC patients are needed.
authors.affiliation: Department of Obstetrics and Gynecology, University of Tuebingen, Calwerstraße 7, 72076, Tübingen, Germany. cwallwiener@gmail.com.|Department of Women's Health, University of Tuebingen, Calwerstrasse 7, 72076, Tübingen, Germany. cwallwiener@gmail.com.
authors.forename: C W
authors.initials: CW
authors.lastname: Wallwiener
authors.affiliation: Department of Obstetrics and Gynecology, University of Tuebingen, Calwerstraße 7, 72076, Tübingen, Germany.
authors.forename: A D
authors.initials: AD
authors.lastname: Hartkopf
authors.affiliation: Department of Obstetrics and Gynecology, University of Tuebingen, Calwerstraße 7, 72076, Tübingen, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Grabe
authors.affiliation: Department of Obstetrics and Gynecology, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Wallwiener
authors.affiliation: Department of Obstetrics and Gynecology, University of Tuebingen, Calwerstraße 7, 72076, Tübingen, Germany.
authors.forename: F-A
authors.initials: FA
authors.lastname: Taran
authors.affiliation: Department of Obstetrics and Gynecology, University of Duesseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Fehm
authors.affiliation: Department of Women's Health, University of Tuebingen, Calwerstrasse 7, 72076, Tübingen, Germany.
authors.forename: S Y
authors.initials: SY
authors.lastname: Brucker
authors.affiliation: Department of Obstetrics and Gynecology, University of Tuebingen, Calwerstraße 7, 72076, Tübingen, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Krämer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D012189:Retrospective Studies; D016019:Survival Analysis
keywords: Age; Breast cancer; Elderly; Postmenopausal women; Survival; Treatment response