Chemotherapy May Help Older Women with Breast Cancer

Older and younger women derived similar decreases in death rates from breast cancer and in rates of recurrence when they were on regimens containing a more aggressive form of chemotherapy, according to a study reported in the Journal of the American Medical Association (JAMA).

Chemotherapy has traditionally not been recommended for older women, those over the ages of 65 or 70, after breast cancer surgery.

"Historically, there have been some biases against older women in terms of could they tolerate the [chemotherapy] treatment and whether they would benefit from it," says Dr. Arash Naeim, at the University of California, Los Angeles.

"The number of women over age 70 in clinical trials [testing chemotherapy regimens] is limited," says Dr. Naeim. " And so it is difficult to draw inferences."

Dr. Hyman Muss, a professor of medicine at the University of Vermont and Vermont Cancer Center in Burlington, agrees with Dr. Naeim.

"It's physician bias," he says, explaining that physicians are often protective of older patients and reluctant to subject them to the side effects that sometimes result from intensive chemotherapy regimens.

"With today's life expectancy, a healthy 65-hear-old woman can expect to live another 20 years," says Dr. Muss. "If you have such a woman in your office who has advanced breast cancer with lots of positive lymph nodes, we now have evidence that she should be offered the best chemotherapy available to help improve her life and reduce the risk that she will die of breast cancer."

About half of all new breast cancers in the US are diagnosed in women 65 years or older. Older women are also at higher risk of cancer recurrence, for which chemotherapy is considered an effective treatment.

Yet, these are the very women who are frequently not offered this type of therapy.

Newer Studies Show Benefit

But some recent studies have begun to suggest that chemotherapy should be considered for older women with breast cancer.

One study, led by Dr. Muss, concluded that age alone should not be a reason to rule out chemotherapy in older women who are in good general health.

In the study reported in JAMA, Dr. Muss and his colleagues analyzed data on nearly 6,500 women who took part in clinical trials between 1975 and 1999.

The researchers compared less aggressive chemotherapy with more aggressive treatments. Eight percent of the women were 65 and older, and 2 percent were ages 70 and older.

The researchers found no association between age and disease-free survival. They did find that overall survival was worse for those women ages 65 and older, but that was due to death from causes other than breast cancer.

Also, older women were more likely to die of complications related to chemotherapy treatment (1.5 percent) vs. younger women (0.2 to 0.7 percent).

"The message, at least for healthy older women, is if you're considering chemotherapy and you feel that that's appropriate, then it would be perfectly reasonable to give it," says Dr. Muss.

Treat Each Woman Individually

No one is saying it is best to offer all older women chemotherapy, notes Dr. Naeim.

"It's a very complicated process, the pathway to the treatment decision," he says. "There is no right answer to whether the chemotherapy is the right or the wrong treatment."

Dr. Naeim, who has also published on the topic, says it is important to take the total patient into account when deciding whether to recommend chemotherapy.

"Take an older woman with arthritis, in a wheelchair, with coexisting disease [such as heart problems], who just had surgery for breast cancer," he explains. "The doctor is saying he can give you chemo, and this may help you not get breast cancer down the road.

"That person may not be interested in down the road," says Dr. Naeim. "Their baseline quality of life may not be so good. And having a worse quality of life [during chemotherapy] is not worth it for them, perhaps."

Dr. Naeim continues, "It's easy [for the doctor] to say something improves your survival or quality of life, but it might be that the amount it improves it is so small you may decide it is not worth doing it."

For older women with breast cancer facing treatment decisions, Dr. Naeim offers this advice: "Understand the goals and objectives of the treatment. Patients often don't understand why they are getting [a specific treatment], the purpose of the treatment."

It is wise to ask.

"Ask for alternatives," notes Dr. Naeim. "There is no one right answer and there are multiple options."

Making such decisions should be easier for older women in the future, he says.

"There are more and more researchers actively looking at the older population and the more studies that come out that focus on that, the more information we will have to make rational decisions," says Dr. Naeim.

Always consult your physician for more information.