UVM Study Shows Older Breast Cancer Patients Benefit From Chemotherapy

Not according to Dr. Hyman Muss, professor of medicine. Muss authored a March 2 Journal of the American Medical Association article that analyzed the results of four major clinical studies on chemotherapy treatment in older versus younger women with breast cancer between 1975 and 1999. Muss found that healthy older women who underwent the stronger chemotherapy derived the same benefits as the younger women — they had similar reductions in breast cancer recurrence and lived as long. But some doctors have been reluctant in the past to offer strong chemotherapy to older patients for a variety of reasons, a situation the physician hopes will change.

“With today’s life expectancy, a healthy 65-year-old woman can expect to live another 20 years,” he says. “If you have a 75-year-old woman in your office who has advanced breast cancer with lots of positive lymph nodes and is in good health, we now have evidence, based on the results of this study and others, that she should be offered the best chemotherapy available to help improve her life and reduce the risk that she will die of breast cancer.”

Muss’s work has attracted attention because of the magnitude of the problem it addresses. Roughly 50 percent of new breast cancers in the United States occur in women aged 65 or older, and, every year, about 40,000 people die from breast cancer. Joanne Neubert, a retired teacher from North Hero, is one of those people covered by those statistics. Now 67 and cancer-free, she underwent intensive chemotherapy treatment when she was 65 and tolerated it very well. “I’m just as capable of surviving as well as anybody else,” says Neubert, who recently returned from a Hawaiian cruise with her husband.

For the study, Muss led the analysis of data from four randomized clinical trials from the Cancer and Leukemia Group B arm of the National Cancer Institute. These trials compared more aggressive with less aggressive chemotherapy regimens for the treatment of lymph node-positive breast cancer cases between 1975 and 1999. A total of 6,487 women with lymph node-positive breast cancer were included in the trials. A startlingly small number — 8 percent — of the patients were 65 years or older and only 2 percent were 70 years or older.

So why are physicians hesitating to offer these stronger chemotherapy treatments to their older breast cancer patients? “It’s physician bias,” says Muss, who explains that doctors are often protective of older patients and reluctant to subject them to the debilitating side effects that sometimes result from intensive chemotherapy regimens

Muss and his colleagues hope that their study’s conclusions will encourage clinicians to offer healthy older patients both the best treatment available, as well as the opportunity to participate in newer clinical treatment trials. Muss recommends that older breast cancer patients, or their family members or loved ones, ask their doctors if chemotherapy treatment is appropriate for them. The key to ensuring older breast cancer patients get the best treatment, says Muss, is open communication between patients and physicians.

To find out more about current CALGB studies taking place through the Vermont Cancer Center at the University of Vermont, call (802) 656-4909 or visit VCC Adult Trials (http://www.vermontcancer.org/getpage.php?pid=114).