The influences of age and co-morbidities on treatment decisions for patients with HER2-positive early breast cancer

Abstract 

Objective

To investigate the influences of age and co-morbidities on the use of adjuvant chemotherapy and trastuzumab in patients with HER2-positive early breast cancer.

Methods

Thirty surgeons and 101 oncologists reviewed the profiles of 16 hypothetical patients which included details of age, tumour size/grade, nodal/ER status, and co-morbidities. Respondents viewed different patient profiles. Oncologists were asked how likely they would be to prescribe chemotherapy ±trastuzumab. Surgeons were asked whether they would refer to an oncologist.

Results

Oncologists’ treatment decisions were most affected by age and co-morbidities: 81% would prescribe chemotherapy for a high-risk patient aged 68 years, but only 47% for an otherwise identical patient aged 73 years. The majority of surgeons (84%) would still refer older patients.

Conclusions

National variation in the use of adjuvant chemotherapy in women aged ≥70 years with high-risk breast cancer is substantial. Practice audits or clinical trials addressing the outcomes of systemic adjuvant therapy are needed for this ever-increasing population of patients.

Keywords: Geriatric oncology, Adjuvant chemotherapy, Trastuzumab, Breast cancer