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Annals of Oncology Advance Access published online on October 13, 2009
Annals of Oncology, doi:10.1093/annonc/mdp364
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© The Author 2009. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

Standard treatment of female patients with breast cancer decreases substantially for women aged 70 years and older: a German clinical cohort study

K. Hancke1,*, M. D. Denkinger2, J. König3, C. Kurzeder1, A. Wöckel1, D. Herr1, M. Blettner3 and R Kreienberg1

1 Department of Obstetrics and Gynecology, University of Ulm Medical School, Ulm
2 Geriatric Department, Bethesda Geriatric Clinic, University of Ulm, Ulm
3 Institute of Medical Biostatistics, Epidemiology and Informatics, University of Mainz, Mainz, Germany

* Correspondence to: Dr K. Hancke, Universitätsfrauenklinik Ulm, Prittwitzstrasse 43, 89075 Ulm, Germany. Tel: +49 731 50058582; Fax: +49 731 50058502; E-mail: ka_hancke{at}yahoo.de

Background: Standard treatment of patients with breast cancer decreases with age and older persons are mostly excluded from clinical trials. We hypothesized that non-adherence to treatment guidelines occurs for women aged ≥70 years and changes overall survival (OAS) and disease-free survival (DFS).

Patients and methods: We enrolled 1922 women aged ≥50 years with histologically confirmed invasive breast cancer treated at the University of Ulm from 1992 to 2005. Adherence to guidelines and effects on OAS and DFS for women aged ≥70 years was compared with that for younger women (50–69 years).

Results: Women >70 years less often received recommended breast-conserving therapy (70–79 years: 74%–83%; >79 years: 54%) than women aged ≤69 years (93%). Non-adherence to the guidelines on radiotherapy (<70 years: 9%; 70–79 years: 14%–27%; >79 years: 60%) and chemotherapy (<70 years: 33%; 70–79 years: 54%–77%; > 79 years: 98%) increased with age. Omission of radiotherapy significantly decreased OAS [≤69 years: hazard ratio (HR) = 3.29; P <0.0001; ≥70 years: HR = 1.89; P = 0.0005] and DFS (≤69 years: HR = 3.45; P <0.0001; ≥70 years: HR = 2.14; P <0.0001). OAS and DFS did not differ significantly for adherence to surgery, chemotherapy, or endocrine therapy.

Conclusion: Our study confirms that substandard treatment increases considerably with age. Omission of radiotherapy had the greatest impact on OAS and DFS in the elderly population.

disease-free survival, elderly, overall survival, radiotherapy, standard treatment

Received for publication September 29, 2008. Revision received February 16, 2009. Accepted for publication June 22, 2009.


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