Management of breast cancer in elderly individuals: recommendations of the International Society of Geriatric Oncology.

Breast cancer is the most commonly diagnosed cancer and the leading cause of cancer mortality in women worldwide. Elderly individuals make up a large part of the breast cancer population, and there are important specific considerations for this population. The International Society of Geriatric Oncology created a task force to assess the available evidence on breast cancer in elderly individuals, and to provide evidence-based recommendations for the diagnosis and treatment of breast cancer in such individuals.

Use of postmastectomy radiotherapy in older women.

Purpose: Clinical trials and guidelines published between 1997 and 2001 concluded that postmastectomy radiotherapy (PMRT) improves overall survival for women with high-risk breast cancer. However, the effect of these findings on current practice is not known. Using the Surveillance, Epidemiology, and End Results-Medicare cohort, we sought to characterize the adoption of PMRT from 1992 to 2002 and identify risk factors for PMRT omission among high-risk older patients.

Renaming "chemobrain".

A subset of breast cancer survivors are reporting cognitive impairment after cancer treatment, which has commonly been attributed to the receipt of chemotherapy and colloquially termed "chemobrain." For some, a fear of this side effect enters into their decision regarding therapy. Our review of the literature reveals that so-called "chemobrain" is complex and that factors other than chemotherapy may affect cognitive function, including the impact of surgery and anesthesia, hormonal therapy, menopause, anxiety, depression, fatigue, supportive care medications, genetic predisposition, comorbid medical conditions, or possibly paraneoplastic phenomenon.

Identifying vulnerable older adults with cancer: integrating geriatric assessment into oncology practice.

Objectives: To integrate the principles of geriatric assessment into the care of older patients with cancer in order to identify vulnerable older adults and develop interventions to optimize cancer treatment.

Design: A brief, comprehensive, self-administered questionnaire and intervention algorithm were developed consisting of measures of geriatric assessment that are brief, reliable, validated, and predictive of mortality and morbidity in older patients.

Setting: Academic tertiary care cancer center and community-based satellite practice.

Comprehensive geriatric assessment for older patients with cancer.

Purpose: During the last decade, oncologists and geriatricians have begun to work together to integrate the principles of geriatrics into oncology care. The increasing use of a comprehensive geriatric assessment (CGA) is one example of this effort. A CGA includes an evaluation of an older individual's functional status, comorbid medical conditions, cognition, nutritional status, psychological state, and social support; and a review of the patient's medications.

Clinical trials in older adults with cancer: past and future.

The risk of cancer increases with age, and as the U.S. population rapidly ages, the number of older adults seeking treatment for cancer is also increasing dramatically.

Is cognitive dysfunction a complication of adjuvant chemotherapy in the older patient with breast cancer?

For a number of years, patients have anecdotally reported changes in memory and concentration problems after receiving chemotherapy for breast cancer. Neuropsychological studies have been performed to seek objective evidence as to the existence and extent of this phenomenon; however, these studies were primarily performed in younger women and there is sparse data regarding the impact of adjuvant chemotherapy on an older woman's cognition. The objective of this paper was to evaluate the current literature in order to propose ways to overcome methodological limitations of studies to consider whether chemotherapy-associated cognitive dysfunction exists in older patients and if so, who is at risk.

Pharmacokinetics of chemotherapy in the older patient.

Background: The number of individuals aged 65 years and older is growing rapidly, and the majority of cancers are diagnosed in this age group. Age-related changes in physiology can affect chemotherapy pharmacokinetics and pharmacodynamics in older patients.

Methods: We review the literature regarding the impact of age on the pharmacokinetics of commonly used chemotherapy drugs and discuss age-related changes in physiology and pharmacology that can affect chemotherapy tolerance in older patients.

Adjuvant treatment recommendations in older women with breast cancer: a survey of oncologists.

Objective: Previous studies demonstrate differing treatment patterns between older and younger patients with breast cancer. To explore the reasons for these disparities we conducted a survey of 28 oncologists specializing in breast cancer.

Design And Methods: Twenty-eight medical oncologists from Memorial Sloan-Kettering Cancer Center and the University of California Los Angeles who specialize in the treatment of breast cancer were asked to provide adjuvant treatment recommendations in hypothetical scenarios featuring older patients with high-risk breast cancer.

Pharmacokinetics and toxicity of weekly docetaxel in older patients.

Purpose: To evaluate the pharmacokinetics of weekly docetaxel in a cohort of older patients with metastatic cancer and to explore the relationship of pharmacokinetic variables, Erythromycin Breath Test results, age, geriatric assessment variables, and toxicity to therapy.

Experimental Design: Twenty patients ages > or = 65 years with metastatic breast, prostate, or lung cancer entered an Institutional Review Board-approved protocol to evaluate the pharmacokinetics of weekly docetaxel administered at 35 mg/m2 i.v.

Postmastectomy radiation and survival in older women with breast cancer.

Purpose: Clinical trials indicate that postmastectomy radiation therapy (PMRT) improves survival for women age younger than 70 years with high-risk breast cancer. However, for women age 70 years or older, the benefits of PMRT are unknown. As recent evidence suggests that certain adjuvant treatments appropriate for younger women may only be marginally beneficial for older women, we sought to determine whether PMRT improves survival for older women with breast cancer.

A prospective, longitudinal study of the functional status and quality of life of older patients with breast cancer receiving adjuvant chemotherapy.

Objectives: To examine the toxicity experienced by a cohort of older women receiving adjuvant chemotherapy for breast cancer and the longitudinal effect on their functional status and quality of life (QOL).

Design: A geriatric assessment measuring functional status, comorbidity, mood, nutritional status, and QOL was performed before chemotherapy, at the end of chemotherapy, and 6 months later.

Setting: This prospective longitudinal study was conducted at Memorial Sloan-Kettering Cancer Center, New York, New York.

Do age and ethnicity predict breast cancer treatment received? A cross-sectional urban population based study. Breast cancer treatment: age and ethnicity.

Purpose: To evaluate the treatment patterns of women aged 55 years or older with newly diagnosed breast cancer and to examine the association between age and ethnicity/race on treatment selection.

Methods: A cross-sectional survey between January 1 and June 30, 2001 of 401 women was performed of Hispanic, black and non-Hispanic white women in Los Angeles County, aged 55 years or older with newly diagnosed breast cancer. Regression analysis examined the association between: (a) age and treatment selection and (b) ethnicity/race and treatment selection, adjusting for the effect of possible confounders.

Geriatric assessment for oncologists: rationale and future directions.

Sixty percent of all cancer occurrences and seventy percent of cancer mortalities occur in people over the age of 65. As the population ages, there is an emerging need to develop a means for oncologists to characterize the "functional age" of older patients with cancer in order to tailor treatment decisions and stratify outcomes based on factors other than chronological age and to develop interventions to optimize cancer treatment. In this paper, we discuss the formulation of a geriatric assessment for older patients with cancer.

Adjuvant chemotherapy and survival in older women with hormone receptor-negative breast cancer: assessing outcome in a population-based, observational cohort.

Purpose: For older breast cancer patients, there is limited evidence of the efficacy of adjuvant chemotherapy from randomized clinical trials. Our goal was to assess the relationship between adjuvant chemotherapy use and survival in a large, population-based cohort of older women with hormone receptor (HR) -negative breast cancer.

Methods: We identified women age 66 and older diagnosed with HR-negative, nonmetastatic breast cancer from 1992 to 1999 in the Surveillance, Epidemiology and End Results (SEER) cancer registries.

Cognitive function of older patients receiving adjuvant chemotherapy for breast cancer: a pilot prospective longitudinal study.

Objectives: To report on the longitudinal cognitive functioning of older women receiving adjuvant chemotherapy for breast cancer.

Design: Neuropsychological and functional status testing were performed before chemotherapy and 6 months after chemotherapy.

Setting: Cancer center.

Effect of adjuvant breast cancer chemotherapy on cognitive function from the older patient's perspective.

Purpose: This longitudinal prospective study describes the older breast cancer patient's perception of the cognitive impact of adjuvant chemotherapy.

Methods: A total of 50 patients > or =age 65 with stage I to III breast cancer enrolled in this IRB-approved prospective study. Of the 50, 3 refused postchemotherapy testing and 2 had a cerebrovascular accident (CVA) during therapy, leaving 45 evaluable patients.

Developing a cancer-specific geriatric assessment: a feasibility study.

Background: As the U.S. population ages, there is an emerging need to characterize the "functional age" of older patients with cancer to tailor treatment decisions and stratify outcomes based on factors other than chronologic age.

Effect of creatinine clearance on patterns of toxicity in older patients receiving adjuvant chemotherapy for breast cancer.

Objective: A number of age-related physiological changes contribute to an increased risk of toxicity of cancer chemotherapy in the elderly. One of the most important of these changes is the progressive decline in renal function with aging. We sought to determine the association between calculated creatinine clearance (CL(CR)) and grade 3 or 4 toxicities during adjuvant chemotherapy in women > or =65 years of age with breast cancer.

Change in cycle 1 to cycle 2 haematological counts predicts toxicity in older patients with breast cancer receiving adjuvant chemotherapy.

Purpose: To determine the association between changes in complete blood counts and grade 3 or 4 toxicities from cycle 1 to cycle 2 during adjuvant chemotherapy in women > or =65 years of age with breast cancer.

Design And Methods: A retrospective review was performed on 1405 patients > or =65 years of age who were treated for primary invasive breast cancer at Memorial Sloan-Kettering Cancer Center between January 1998 and December 2000. From this cohort, we identified patients with stage I-III breast cancer who received adjuvant chemotherapy: cyclophosphamide, methotrexate and fluorouracil (CMF) or the anthracycline-based regimens doxorubicin and cyclophosphamide (AC) or AC followed by paclitaxel (AC-T).

Patterns of toxicity in older patients with breast cancer receiving adjuvant chemotherapy.

Objective: To retrospectively determine the relationship of age to toxicity from adjuvant chemotherapy for breast cancer.

Design And Methods: We identified 1,405 consecutive patients age 65 or older with primary invasive breast cancer who were seen at Memorial Sloan-Kettering Cancer Center from January 1998 to December 2000. Patients selected from this cohort for analysis were aged 65 or older at diagnosis; received their follow-up care at Memorial Sloan-Kettering Cancer Center; had stage I, II, or III breast cancer; and received adjuvant chemotherapy consisting of CMF (cyclophosphamide, methotrexate, and 5-fluorouracil), an anthracycline-based regimen (AC [doxorubicin and cyclophosphamide], or AC-T [AC and paclitaxel or docetaxel]).

Phase II study of feasibility of dose-dense FEC followed by alternating weekly taxanes in high-risk, four or more node-positive breast cancer.

Purpose: To develop a potentially superior adjuvant chemotherapy regimen, we conducted a pilot study of dose-dense 5-fluorouracil, epirubicin, and cyclophosphamide (FEC) followed by weekly alternating taxanes. The primary objective was to determine the feasibility of the regimen; the secondary objective was to estimate the disease-free and overall survival.

Experimental Design: Patients with >/=4 node-positive breast cancer were studied.

Management of lung cancer in older adults.

Lung cancer is the leading cause of cancer death in the United States. At the time of diagnosis, most patients are older than 65 years and have Stage III or IV disease. More than 80% of patients have non-small cell lung cancer and the rest have small cell lung cancer.