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Cancers 2015, 7(3), 1191-1214; doi:10.3390/cancers7030833

Adjuvant Systemic Therapy in Older Breast Cancer Women: Can We Optimize the Level of Care?

Sandro Pitigliani Medical Oncology Unit, Nuovo Ospedale Santo Stefano, Instituto Toscano Tumori, 59100 Prato, Italy
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Academic Editor: Jonas Cicenas
Received: 4 May 2015 / Revised: 17 June 2015 / Accepted: 26 June 2015 / Published: 3 July 2015
(This article belongs to the Special Issue Cancers and Aging)
View Full-Text   |   Download PDF [613 KB, uploaded 3 July 2015]   |  

Abstract

Defining optimal adjuvant treatment for older women with breast cancer is challenged by the lack of level-1 clinical evidence and the heterogeneity of the older population. Nevertheless, recommendations based on reviews of available evidence mainly from retrospective subgroup analyses and extrapolation of study results from younger patients, and expert opinions, may be useful to guide treatment decisions in fit patients. But how can we properly define a “fit” older patient? In clinical practice, age by itself and clinical impression generally drive treatment decision, although the appropriateness of this judgment is under-documented. Such an approach risks overtreatment or, more frequently, undertreatment. A geriatric assessment can be valuable in oncology practice to address this issue. In this review article, we will focus only on systemic treatment and will discuss “standard” adjuvant systemic treatment strategies for fit older breast cancer patients and the role of “personalized” systemic therapy in unfit patients. The concepts conveyed in this review cannot be extrapolated to locoregional therapy. View Full-Text
Keywords: breast cancer; elderly; fitness for treatment; decision-making; geriatric oncology; adjuvant therapy; geriatric assessment breast cancer; elderly; fitness for treatment; decision-making; geriatric oncology; adjuvant therapy; geriatric assessment
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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Mislang, A.R.; Biganzoli, L. Adjuvant Systemic Therapy in Older Breast Cancer Women: Can We Optimize the Level of Care? Cancers 2015, 7, 1191-1214.

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