Aim - To review factors impeding the optimal delivery of adjuvant chemotherapy in older women with early stage breast cancer and to elucidate potential strategies to improve treatment outcomes in this age group.
Methods - A literature review was conducted to investigate factors implicated in the suboptimal treatment of elderly breast cancer patients and to determine the current consensus on how to best clinically manage this cohort. In particular, the prognostic significance of maintaining dose intensity in this population was examined.
Results - Factors implicated in the under-treatment of elderly breast cancer patients include: the erroneous historical consensus that adjuvant chemotherapy regimens were poorly tolerated in the elderly, age bias in prescribing treatments, sub-optimal health status in this demographic, age-related discrepancies in patient preference as well as pathological tumour characteristics and a paucity of clinical research in this age group. The most important factor in improving survival outcomes amongst the elderly was found to be the maintenance of optimal dose intensity (defined as a relative dose intensity ≥85%) and strategies implicated in achieving this include the rigorous management of treatment-related toxicities, tailoring treatment to tumour and patient factors and avoiding undue reliance on age as a singular treatment criterion, and the implementation of various clinical assessment tools, such as the Comprehensive Geriatric Assessment.
Conclusions - Current evidence suggests that maintenance of dose intensity is key to optimizing the adjuvant chemotherapy treatment of elderly breast cancer patients. As there is a notable lack of clinical research in demographic, especially concerning the tolerability of newer adjuvant chemotherapy regimens, further research in this field is warranted, with a view to improving the delivery of care in this age group.