title: Impact of Adjuvant Chemotherapy in Elderly Breast Patients
  in Taiwan, A Hospital-Based Study
abstract: Purpose: Decisions as to whether to provide adjuvant treatment in older breast cancer patients remains challenging.
  Side effects of chemotherapy have to be weighed against life expectancy, comorbidities, functional status, and frailty.
  To aid decision-making, we retrospectively analyzed 110 women with breast cancer treated with a curative intention
  from 2006 to 2012. Survival data with clinical and pathological parameters were evaluated to address the role of
  adjuvant chemotherapy in this study population. Method: A total of 110 elderly (>70 years) patients that received
  mastectomy at two hospitals in Taiwan were observed retrospectively for a medium of 51 months. After mastectomy,
  patients received conservative treatment or adjuvant chemotherapy, or hormone therapy following clinical guidelines
  or physician’s preference. Data were collected from the cancer registry system. Results: Median age at diagnosis was
  75.7 years. Thirty-five percent of patients received adjuvant chemotherapy, these having a significantly younger age
  (mean=74.0±5.3 vs 77.5±5.3, p<0.001) and higher tumor staging (p=0.003) compared with their non-chemotherapy
  counterparts.Five-year overall survival was non-significantly higher in patients who received adjuvant chemotherapy
  (with chemotherapy 64.2% vs without chemotherapy 62.6%, p=0.635), while five-year recurrence free survival was
  non-significantly lower (with chemotherapy 64.1% vs without chemotherapy 90.5%, p=0.80). Conclusions: In this
  analysis, adjuvant chemotherapy tended to be given to patients with a younger age and higher tumor staging at our
  institute. It was not associated with any statistically significant improvement in survival and recurrence rate. Until
  age specific recommendations are available, physicians must use their clinical judgment and assess the tumor biology
  with the patient’s comorbidities to make the best choice. Clinical trials focusing on this critical issue are warranted.
authors.affiliation: Department of Internal Medicine, Chi-Mei Medical Center, Yong Kang, Tainan, Taiwan, Email: yinhsun.feng@gmail.com.
authors.forename: Hsiu-Chuan
authors.initials: HCh
authors.lastname: Lee
authors.forename: Wei-Yu
authors.initials: WY
authors.lastname: Chen
authors.forename: Wen- Tsung
authors.initials: WN
authors.lastname: Huang
authors.forename: Kuo- Chen
authors.initials: KO
authors.lastname: Cheng
authors.forename: Yu-Feng
authors.initials: YF
authors.lastname: Tian
authors.forename: Chung-Han
authors.initials: ChH
authors.lastname: Ho
authors.forename: Chao- Jung
authors.initials: ChO
authors.lastname: Tsao
authors.forename: Yin- Hsun
authors.initials: YN
authors.lastname: Feng
keywords: Breast cancer; adjuvant chemotherapy; elderly