Chemotherapy for Elderly Patients with Breast Cancer

About breast cancer chemotherapy?

Dear Director Lai,
I apologize for the intrusion.
My mother is 76 years old and was diagnosed with stage II breast cancer in February of this year (with a 2.5 cm tumor in the left breast; CT and bone scans showed no metastasis).
She underwent surgery in March to remove the left breast and lymph nodes.
After reviewing the surgical pathology report, the hematologist-oncologist indicated that due to one lymph node metastasis, targeted therapy would be covered by health insurance.
Regarding the subsequent treatment plan, the oncologist stated that "based on health insurance regulations, chemotherapy must be administered first," followed by targeted therapy (for one year) and hormone therapy (for five years).

I would like to ask if, considering my mother's advanced age and her potentially reduced tolerance for chemotherapy side effects, it is still not possible to skip the chemotherapy phase and proceed directly to targeted therapy? Thank you for your assistance.
Best wishes!

Mr. Huang, 40~49 year old female. Ask Date: 2016/04/13

Dr. Lai Yicheng reply Oncology

Dear Mr.
Huang,
I understand from your letter that according to the National Health Insurance guidelines for targeted therapy, your mother must first complete chemotherapy before being eligible for "Hecancerping." If you wish to use the targeted medication directly, not only will the efficacy be suboptimal, but it will also be an out-of-pocket expense (approximately 700,000 to 800,000 NTD per year), which I do not recommend.
As for the chemotherapy drugs, your physician should consider "Cranberry." If you are concerned about side effects, please discuss with your physician whether the dosage needs to be adjusted.
Best regards,
Dr.
Lai, Department of Radiation Oncology, Changhua Hospital

Reply Date: 2016/04/13

More Info

When it comes to the treatment of breast cancer in elderly patients, particularly those diagnosed with stage II breast cancer, the decision-making process can be complex and multifaceted. Your mother, at 76 years old, has been diagnosed with a 2.5 cm tumor and has undergone surgery to remove the left breast and lymph nodes. The presence of lymph node involvement indicates a higher risk of recurrence, which is why the oncologist has recommended chemotherapy followed by targeted therapy and hormonal treatment.

Chemotherapy is often a standard part of treatment for breast cancer, especially when there is lymph node involvement. It aims to eliminate any remaining cancer cells that may not have been removed during surgery. However, the decision to proceed with chemotherapy in elderly patients must take into account several factors, including the patient's overall health, the presence of comorbidities, and their ability to tolerate the side effects of chemotherapy.

Elderly patients may experience more pronounced side effects from chemotherapy due to age-related physiological changes and the potential presence of other health conditions. Common side effects include fatigue, nausea, hair loss, and an increased risk of infections due to lowered blood cell counts. Therefore, it is crucial to assess your mother's overall health status and discuss any concerns regarding her ability to tolerate chemotherapy with her oncologist.

In some cases, oncologists may consider alternative treatment approaches for elderly patients, especially if they have significant comorbidities or if the cancer is deemed to be less aggressive. However, in your mother's case, the oncologist has indicated that chemotherapy is necessary based on the guidelines and the specifics of her cancer diagnosis. The requirement to undergo chemotherapy before starting targeted therapy (such as trastuzumab) is often dictated by insurance coverage and treatment protocols, which can vary by region and healthcare system.

If your mother is concerned about the side effects of chemotherapy, it is essential to have an open discussion with her oncologist. They can provide insights into the expected side effects, potential dose adjustments, and supportive care options to help manage any adverse effects. Additionally, the oncologist may consider geriatric assessments to tailor the treatment plan to your mother's specific needs.

In summary, while chemotherapy is a standard recommendation for patients with lymph node involvement in breast cancer, the decision should be individualized based on the patient's overall health and preferences. It is crucial to have thorough discussions with the healthcare team to ensure that your mother receives the most appropriate care while considering her quality of life. If there are concerns about the necessity of chemotherapy or the possibility of alternative treatments, these should be addressed directly with her oncologist.

Similar Q&A

Understanding Chemotherapy Decisions for Elderly Cancer Patients

Dear Dr. Fan, My mother is 78 years old and discovered a lump in her breast in February. She underwent surgery at Dalin Tzu Chi Hospital, where a biopsy confirmed it was cancer. A few weeks after the surgery, we received the pathology report, which indicated it was stage II and ...

Dr. Fan Sheng reply Oncology
Dear Mr. Yuan, Hello. First of all, considering your mother's age, it is highly likely that her breast cancer specimen's estrogen receptor (ER) is positive. If this is the case, I recommend administering the oral estrogen receptor antagonist Tamoxifen for two years, fo...

Understanding Lung Tumors: Treatment Options for Elderly Patients

Hello, my grandmother is nearly 90 years old, weighs 48 kg, and is able to take care of herself. She requires a cane to walk due to knee joint degeneration. She has been experiencing a long-term cough and has only been receiving cough and expectorant medication from the clinic. R...

Dr. Ke Zhengchang reply Pulmonology
Hello: Based on your description, if a 90-year-old patient has lung cancer, the first step is to identify the type of cancer cells and determine the stage of the lung cancer. If it is stage I or II, radiation therapy or surgical resection may be considered (provided that cardiac ...

Should My 67-Year-Old Mother with 1cm Breast Cancer Undergo Chemotherapy?

Dear Dr. Lai, My mother is currently 67 years old and has hypertension. She is continuously taking medications including Clonidine, Bisoprolol, and Amlodipine. She also has bone spur issues and poor leg strength. In July, a black spot was detected in her left breast, and a biops...

Dr. Lai Yicheng reply Oncology
Hello Ms. Lai: Whether adjuvant chemotherapy is needed after breast cancer surgery primarily depends on the tumor size. For example, if the tumor is larger than 1 cm or there is axillary lymph node metastasis, adjuvant chemotherapy is recommended. Here, it is important to explain...

Is Chemotherapy Suitable for Elderly Patients After Pancreatic Cancer Surgery?

Dear Dr. Chen, I would like to ask you a few questions regarding my mother, who is 88 years old. She underwent surgery for a pancreatic tumor in mid-May, and nearly three months later, on July 20, her CA 19-9 level was 408. On August 5, her CA 19-9 level rose to 3390, while her ...

Dr. Chen Yunfang reply Oncology
Hello: Based on the questions you raised, I can see that you have thought deeply and far about future matters. Pancreatic cancer surgery is considered one of the most complex procedures in surgery (it is difficult to perform, the operation time is extremely long, and the wound ta...