Half of all new cancer cases occur in people older than 65, yet a growing body of evidence shows that elderly patients are chronically underrepresented in clinical trials. Moreover, it has been presumed that older patients cannot handle the aggressive chemotherapy used on younger patients, given that concurrent illnesses are common. But because there has been so little data on the effects of standard treatment regimens on older patients, physicians are often forced to make decisions about patient care in the absence of clear scientific evidence. These studies document the fact that elderly patients are less frequently enlisted as research participants than are younger patients. They also demonstrate that special considerations may apply in planning cancer treatment strategies for elderly patients, since these patients may either suffer increased toxicities from treatment, or may display unexpected benefits.
Additional research is needed to provide insights into how best to treat an aging population.
This study demonstrates that older women receiving adjuvant chemotherapy do not experience clinically significant increases in toxicity. These findings suggest that older age alone should not exclude women with breast cancer from receiving this chemotherapy regimen or from participating in clinical trials. While the previous study demonstrates that older breast cancer patients with early stage breast cancer can tolerate standard adjuvant chemotherapy, this study finds that elderly patients whose breast cancer has spread to the lymph nodes do not appear to be able to tolerate standard chemotherapy using the more toxic drug Methotrexate as well as younger patients. In the study, patients under 65 years of age experienced less toxicity than patients between the ages of 65-70. This finding will help physicians tailor oncology care to this patient population, providing as much active treatment as can be tolerated, and selecting the most appropriate active drugs available.