Should less treatment be offered to 'older' women with BC? Over 70s ....

arpie

A bit disconcerting to read a report, released on Dec 6th 2023, that there may be talk of offering less treatment options to 'older women' (ie over 70s) when diagnosed with Breast Cancer.  Maybe they need to ask their mother or grandmother to see if this is acceptable to what they would want, if they were diagnosed with BC?  I think most would choose normal treatment, rather than 

In the USA, Women age 70 or older account for almost a third of new diagnoses ..... which to me, indicates that the numbers are increasing - and unfortunately, the 'earlier deaths' associated with being 'older with BC' also increase ..... at approx 1 in 4 may not make it to 5 years!


I would hope, that every 'older' woman would be assessed individually on their actual physical & mental ability to receive the surgery/treatment - obviously dependent on the stage/level of their BC - with explanations of why specific treatments would be with-held?

We (70 & older) are generally MUCH more fit & active than our parents ever were at the same age - personally, I look at 70 being the new '60' .... and prior to BC diagnosis at age 65, I was fit & healthy, very active - but, 5 years later, my fitness & activity has been affected as a result of my BC meds ... 

They mention the likelihood of 'older' women stopping taking their AIs, possibly increasing the chance of a recurrence ... but this happens with EVERY age group as this publication shows - with the 'dropouts' being anywhere between 10-50%, depending on which publication you read - and are ALL women being totally honest with their Onc & TELLING them they have stopped?  I think, probably not:
https://www.breastcancer.org/research-news/poor-quality-of-life-linked-to-stopping-hormonal-therapy-treatment-early

Have a read of these inks & see what you make of it?

From the articles on reducing treatment: 

Clinical studies of strategies to reduce locoregional recurrence in older patients have examined ways to reduce the aggressiveness (de-escalate) of breast cancer treatment. However, consideration of de-escalated treatment inherently involves caveats. They are hoping to strike a balance between 'too much therapy' and 'not enough' ..... :
https://www.medpagetoday.com/clinical-challenges/sabcs-breast-cancer/107700

Not too little, not too much - optimizing more vs less treatment for older patients with BC:
https://ascopubs.org/doi/full/10.1200/EDBK_390450


This is a tool that has gained some traction in oncology.  (Put your own statistics in & see what the outcome is!) The instrument elicits information that allows the clinician to estimate a patient's likelihood of surviving over different time periods up to 14 years:
https://eprognosis.ucsf.edu/leeschonberg.php

Afraser

Well yes, if you are poor, depressed and having horrible side effects you may well stop
taking hormonal therapy! Duh! I didn’t see too much about age (unless someone is making sweeping assumptions about everyone over 70 being poor and depressed!) and it’s just possible that if the research can clarify quite specific groups at greatest risk
of dropping out then something might be done - finding a way to minimise side effects would be a good start. I sometimes wonder about some of these ‘research’ papers stating the obvious and making strange connections. These ‘findings’ have to be replicated and tested before making changes. 

LadyMacbead

Rather than scaling back on treatment for BC, age 73, but
why is nobody I can locate thus far advocating for older women? I had the lumpectomy 3 days ago, with a couple of lymph nodes, etc, but on first meeting with the Surgeon I was dismayed at what felt like dismissal. 
I am reasonably fit, very healthy; I eat well, we travel overseas, and I am doing rehab for a Reverse Shoulder Replacement. My mental Health is excellent.
Why can I not be treated with the same respect I would expect at 63? 60? Mid 50`s? My life is important too: at least to me and my family!

cranky_granny

This better not be true. I might only be 67 with mets. Only just became eligible for age pension. Why would I stop trying to live longer I spent years working and looking after a disabled husband never asked for carers allowance until he was in his last days and i had to give up work during that time. 

So in 3 years I might have to look at should I stop the treatment that is working and risk it all. It’s quality of life choice not an age thing. 

Grrr bah humbug who comes up with this crap. Obviously someone who hasn’t lived this experience. 

arpie

I agree with you, 100%  @LadyMacbead.   Specially now that I am 70 too!   

I hope you are recovering well from your surgery & wishing you all the best for your pathology results &  your next round of appointments & treatment options. xx. Take care

Check out this post for lots of info on the forum 'in general' and some of the other areas you may like to participate in!!
https://onlinenetwork.bcna.org.au/discussion/23477/a-big-welcome-to-all-our-new-members#latest

@cranky_granny - that article came out of the USA in Dec last year - and often Australia follows the American 'ways' ..... tho I hope they DON'T with this one.  Our lives are just as valuable as everyone else & we deserve a fighting chance!  We've also paid our taxes .....

cranky_granny

@arpie I read the article after posting hopefully Australia has more sense than to follow US in that one. We have a decent healthcare system often people there go without treatments due to the cost 

SuzyS

I was diagnosed last year at 73. I have to say I was treated wonderfully by my surgeon, both my raiotheraphy oncologist and my medical oncologist. No one mentioned my being in my 70s except my radio oncololoist who said it was nice to have a 'younger' patient - she'd had women in their 80s for treatment recently.
I certainly hope women over 70 don't get written off as not worthy of treatments.

CRM

In the USA patients are often 'over treated' in comparison to Australia. In Australia it is common to treat ER+ PR+ HER2- early stage cancer with lumpectomy surgery, 3-4 weeks radiation and 5 years hormone tablets. In the USA those same patients might undergo mastectomy with full axillary clearance, radiation, chemo and 10+ years hormone tablets. If the article is looking at scaling back treatment for early stage hormone positive cancers to be more in line with Australia that might be a good thing.

I totally agree that people in their 70s still have plenty of living to do... putting everyone through unnecessary treatments that can take a decade to recover from might decrease quality of life.