ABSTRACT
Objective: To investigate the current status of adjuvant therapy compliance in elderly breast cancer patients (≥65 years old) attended the case-management model and to analyze the impact of demographic characteristics and clinical features on adjuvant therapy compliance. Methods: This study enrolled 654 elderly early breast cancer patients who were treated in Ruijin Hospital and subsequently accepted case-management model between March 2013 and August 2016. Data on patients' compliance to adjuvant therapies which were designed by multidisciplinary treatment (MDT) were collected. The correlation of patients' adjuvant therapy compliance with demographic characteristics and clinical features were evaluated using χ2 test. The statistically significant variables were taken and the corresponding impact on adjuvant therapy compliance were further analyzed using multiple Logistic regression model. Results: In this study, 603 (92.20%) elderly breast cancer patients were treated with one or a combination of adjuvant therapies according to MDT discussion/recommendation. Overall patients' compliance to adjuvant therapy was 88.05%. 45.94% patients were required adjuvant chemotherapy, of which 91.34% patients complied in reality; 45.61% patients were required adjuvant radiotherapy, of which 88.73% patients complied in reality; 80.93% patients were required adjuvant endocrine therapy, of which 93.65% (median treatment duration 44.16 months) patients complied in reality; 12.94% patients were required adjuvant targeted therapy, of which 82.05% patients complied in reality. By number of adjuvant therapies that elderly early breast cancer patients were required, patients' compliance to one, two, three and four adjuvant therapies amounted to 94.30%, 83.68%, 87.20% and 60.00% respectively. The results from analysis of demographic characteristics and clinical features revealed that, age and number of adjuvant therapies had significant impact on adjuvant therapy compliance in elderly breast cancer patients (P<0.05). Furthermore, patients' education level showed strong correlation with patients' compliance to adjuvant chemotherapy and adjuvant radiotherapy (P<0.05). Additionally metastasis to lymph nodes impacted on patients' compliance to adjuvant chemotherapy (P<0.05). Conclusion: Case-management model is beneficial to improve adjuvant therapy compliance after surgery in elderly breast cancer patients. To further increase patients' compliance, more efforts should be invested to help patients older than 74 years old, with lower education level, negative lymph nodes and more types of comprehensive treatment.
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Objective To analyze the clinical and pathological features of breast cancer in patients over 80 years old, to discuss the individualized treatment plan and further to provide foundation for clinical treatment . Methods Data of 58 breast cancer patients over 80 years old were retrospectively analyzed .They were treated from Jun.2008 to May.2014 and the diagnosis was confirmed by pathology after surgery .They were followed up by telephone.Results Among the 58 cases, invasive cancer accounted for 94.8%(55/58), in which triple-negative breast cancer accounted for 29.1%(16/55), and human epidermal growth factor receptor 2(HER2)pos-itive breast cancer accounted for 7.2%( 4/55 ) .Stage III breast cancer accounted for 24%( 14/58 ) .67.2%(39/58)patients underwent breast resection , 55.2%(32/58)patients underwent axillary treatment , 17.2%(10/58)patients received chemotherapy , and 51.7%(30/58) patients received endocrine therapy .Seven cases had recurrence and 3 cases died of the disease .Conclusions Breast cancer in elderly patients has its special clinical and pathological features .It has longer course , relatively late stage , and more complications .It has higher pro-portion of triple-negative breast cancer and lower proportion of positive HER 2.Elderly breast cancer patients are less tolerant to chemotherapy , thus surgery and endocrine therapy are the main treatment .
ABSTRACT
Background and purpose: The incidence of breast cancer increases as patients age, elderly patients account for a large proportion. Due to the insufifcient systemic therapy, more complications and poorly physical condition, the prognosis of elderly patients is often worse than the younger. The aim of this study was to investigate the safety and tolerance with non-anthracyclin regimen as adjuvant chemotherapy in elderly breast cancer patients. Methods:From Nov. 2008 to Jan. 2012, 56 patients (≥65 years) after surgical excision were enrolled into this study. The patients were divided into two groups:TC and PC groups. Each patient received 4 or 6 cycles of chemotherapy of PC (175 and 600 mg/m2, respectively;n=21) or TC (75 and 600 mg/m2, respectively;n=35), administered intravenously every 3 weeks, as adjuvant chemotherapy. Radiation therapy (as indicated) and endocrine therapy, for patients with hormone receptor-positive disease, were administered after completion of chemotherapy. Results: In this study, 50 patients completed chemotherapy as plan, the proportion of two groups were above 90%. After a median follow-up of 33 months, the median disease-free survival(DFS) and overall survival(OS) were not reached. The relapse-free rate and survival rate were 89.5%and 100%in the PC regime group, which were 90.3%and 96.8%in the TC regime group. Major toxicities included:neutropenia, leucopenia, alopecia, nausea, vomiting and various degree of peripheral neuropathy. The incidence of gradeⅢ-Ⅳneutropenia was 76.2%in PC group vs 48.6%in TC group (P=0.044). The most common cause for withdrawing from treatment was to be unable to tolerate the adverse effects. Conclusion:Adjuvant chemotherapy with paclitaxel and cyclophosphamide is safe, tolerable and promising for elderly breast cancer patients.