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CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2017; 38(04): 526-534
DOI: 10.4103/ijmpo.ijmpo_96_17
Review Article

A Risk‑benefit Assessment Approach to Selection of Adjuvant Chemotherapy in Elderly Patients with Early Breast Cancer: A Mini Review

Vivek Agarwala
Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
,
Neha Choudhary
Department of Surgical Oncology, Breast Surgery Unit, Tata Memorial Centre, Mumbai, Maharashtra, India
,
Sudeep Gupta
Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
› Author Affiliations Financial support and sponsorship Nil.
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Abstract

Decision-making regarding the use and selection of adjuvant chemotherapy for breast cancer in elderly patients is challenging due to the presence of age-relatedcomorbidities, frailty, andcompeting causes of mortality. One area, relatively neglected in most guidelines, is the effect ofcompeting 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 populationcompared to conventional approaches that incorporate tumor-related variables and nonstandard measures of geriatric assessment.

Keywords

Adjuvant chemotherapy - comorbidities - competing causes of mortality - early breast cancer - elderly


Publication History

Article published online:
04 July 2021

© 2017. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used forcommercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

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