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Chemotherapy May Benefit Older People With Estrogen-Receptor-Positive Breast Cancer and Other Health Problems

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People age 70 and older diagnosed with certain estrogen-receptor-positive breast cancers and other health problems who were treated with chemotherapy after breast cancer surgery had better survival than people who weren’t treated with chemotherapy, according to a study.

Still, other factors, including how well a person functions and quality of life, need to be considered when making chemotherapy decisions.

The research was published online on July 16, 2020, by JAMA Oncology. Read the abstract of “Association of Chemotherapy With Survival in Elderly Patients With Multiple Comorbidities and Estrogen Receptor-Positive, Node-Positive Breast Cancer.”

About the study

As women get older, the risk of breast cancer goes up, as does the risk of other serious medical problems, including high blood pressure, congestive heart failure, and chronic obstructive pulmonary disease (COPD).

Much research has been done showing that chemotherapy after surgery to remove breast cancer improves survival. Doctors call treatments given after surgery adjuvant treatments. Still, few people older than 70 with other medical conditions were included in the earlier studies. So there isn’t much information on how beneficial adjuvant chemotherapy is for this group of older people. This is why the researchers did the study.

The study included 1,592 people age 70 and older who had at least two other serious medical conditions who had been diagnosed with estrogen-receptor-positive, HER2-negative, node-positive breast cancer. Node-positive means the breast cancer has spread to one or more lymph nodes.

About 97% of the people in the study were women.

The average age was 77.5 years.

All the people had surgery to remove the breast cancer between Jan. 1, 2010, and Dec. 31, 2014.

Of the 1,592 people in the study:

  • 350 (22%) were treated with chemotherapy after surgery
  • 1,242 (78%) were not treated with chemotherapy

Compared with people who didn’t receive chemotherapy, people who were treated with chemotherapy:

  • were younger; the average age was 74 compared to 78
  • had higher grade breast cancer
  • had larger primary cancer tumors
  • were more likely to have more than one positive lymph node
  • were more likely to also be treated with radiation
  • were more likely to also be treated with hormonal therapy

The other serious medical conditions the people in the study could have had included:

  • heart attack
  • congestive heart failure
  • dementia
  • COPD
  • peptic ulcers
  • liver disease
  • diabetes
  • kidney disease
  • paralysis

All these conditions are considered serious and could potentially affect how long a person lives.

The people were followed for about 3.5 years after breast cancer treatment.

After adjusting for the other risk factors, the researchers found that women who were treated with chemotherapy were 33% less likely to die than women who weren’t treated with chemotherapy.

“Our study found that carefully selected patients within this subset of the population may benefit from additional adjuvant treatment, highlighting the importance of accurately estimating life expectancy in patients with multiple comorbidities,” the researchers wrote. “In addition, genomic tests, such as Oncotype DX, may help to better capture tumor biology and refine patient selection for chemotherapy among those with node-positive disease. Future studies should focus on integrating geriatricians into multidisciplinary breast cancer care to optimize outcomes in less well-studied older patients with multiple comorbidities and node-positive breast cancer.”

What this means for you

If you’re age 70 or older, have been diagnosed with estrogen-receptor-positive, HER2-negative, node-positive breast cancer, and have other serious medical conditions, this study offers some good news. Being treated with chemotherapy after breast cancer surgery may improve your survival.

Still, it’s very important to talk to your doctor about your treatment goals, concerns, and life priorities when deciding on a treatment plan.

The researchers who did this study pointed out that a number of factors besides a person’s age should be considered when deciding on breast cancer treatments, including other medical conditions, a person’s ability to function, and how the treatments will affect quality of life.

“The goal is to avoid compromising a patient's functional status, especially in the context of an already limited life expectancy,” said lead author Nina Tamirisa, M.D., of the MD Anderson Cancer Center in Houston, in an interview. “It is imperative for providers to understand patient priorities with respect to maintaining independence in activities of daily living that could be impacted by toxicities from treatment.”

It’s crucial that your doctor understands what you want to get out of your treatment, as well as your personal preferences on how you want to live your life. It’s also very important that you and your doctor discuss any and all side effects that any breast cancer treatments can cause, including how these side effects might affect the other medical conditions you have.

Together, you can decide on a treatment plan that is best for your unique situation.

Written by: Jamie DePolo, senior editor

Reviewed by: Brian Wojciechowski, M.D., medical adviser

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