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Ann Oncol. 2010 Apr;21(4):748-53. doi: 10.1093/annonc/mdp364. Epub 2009 Oct 13.

Standard treatment of female patients with breast cancer decreases substantially for women aged 70 years and older: a German clinical cohort study.

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  • 1Department of Obstetrics and Gynecology, University of Ulm Medical School, Universitätsfrauenklinik Ulm, Prittwitzstrasse 43, Ulm, Germany. ka_hancke@yahoo.de

Abstract

BACKGROUND:

Standard treatment of patients with breast cancer decreases with age and older persons are mostly excluded from clinical trials. We hypothesized that non-adherence to treatment guidelines occurs for women aged > or =70 years and changes overall survival (OAS) and disease-free survival (DFS).

PATIENTS AND METHODS:

We enrolled 1922 women aged > or =50 years with histologically confirmed invasive breast cancer treated at the University of Ulm from 1992 to 2005. Adherence to guidelines and effects on OAS and DFS for women aged > or =70 years was compared with that for younger women (50-69 years).

RESULTS:

Women >70 years less often received recommended breast-conserving therapy (70-79 years: 74%-83%; >79 years: 54%) than women aged < or =69 years (93%). Non-adherence to the guidelines on radiotherapy (<70 years: 9%; 70-79 years: 14%-27%; >79 years: 60%) and chemotherapy (<70 years: 33%; 70-79 years: 54%-77%; > 79 years: 98%) increased with age. Omission of radiotherapy significantly decreased OAS [< or =69 years: hazard ratio (HR) = 3.29; P <0.0001; > or =70 years: HR = 1.89; P = 0.0005] and DFS (< or =69 years: HR = 3.45; P <0.0001; > or =70 years: HR = 2.14; P <0.0001). OAS and DFS did not differ significantly for adherence to surgery, chemotherapy, or endocrine therapy.

CONCLUSION:

Our study confirms that substandard treatment increases considerably with age. Omission of radiotherapy had the greatest impact on OAS and DFS in the elderly population.

PMID:
19825884
[PubMed - indexed for MEDLINE]
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