Open AccessA risk-benefit assessment approach to selection of adjuvant chemotherapy in elderly patients with early breast cancer: A mini review
Author(s) -
Vivek Agarwala,
Neha Choudhary,
Sudeep Gupta
Publication year - 2017
Publication title -
indian journal of medical and paediatric oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.229
H-Index - 22
eISSN - 0975-2129
pISSN - 0971-5851
DOI - 10.4103/ijmpo.ijmpo_96_17
Subject(s) - medicine , breast cancer , adjuvant chemotherapy , life expectancy , chemotherapy , adjuvant , oncology , cancer , selection (genetic algorithm) , intensive care medicine , population , environmental health , artificial intelligence , computer science
Decision-making regarding the use and selection of adjuvant chemotherapy for breast cancer in elderly patients is challenging due to the presence of age-related comorbidities, frailty, and competing causes of mortality. One area, relatively neglected in most guidelines, is the effect of competing causes of mortality on presumed benefit of adjuvant chemotherapy for breast cancer in these patients. This article utilizes a clinical case to illustrate the principles of risk-benefit assessment of adjuvant chemotherapy in elderly patients. We suggest an approach that incorporates validated tools for estimating survival benefits of adjuvant chemotherapy, geriatric assessment, predicting toxicity, and estimating remaining life expectancy without cancer. Integration of all these variables provides a better picture of the possible benefits and harms of adjuvant chemotherapy in this population compared to conventional approaches that incorporate tumor-related variables and nonstandard measures of geriatric assessment.