Management of Breast Cancer in Older Women

Management of Breast Cancer in Older Women offers the reader evidence-based clinical knowledge of older patients suffering from breast cancer. It presents the most up-to-date research and clinical knowledge from the leading specialists across a range of fields that come into contact with older breast cancer patients. Multidisciplinary in its approach, this book covers all the bases for managing breast cancer in older women. The full armament of therapeutic options is presented, as well as the epidemiology of the disease in older women and the specific psychosocial considerations for older patients. Medical oncologists, gerontologists and all involved in the management of older breast cancer patients will benefit from having this unique and important work on their shelf. Malcolm W Reed, MD, MB ChB, BMedSci, FRCS is Professor of Surgical Oncology based at the University of Sheffield and Sheffield Teaching Hospitals NHS Trust in Sheffield, UK. His extensive research history includes work on hormone receptors in breast cancer and the effect of photodynamic therapy on the tumor microcirculation. Riccardo A Audsio, MD, FRCS is Consultant Surgical Oncologist at St Helens and Knowsley University Hospitals, St Helens, UK. His main research interest is exploring the role of surgery within the multidisciplinary management of cancer patients, particularly focusing on onco-geriatrics, and he currently sits on the editorial board of 12 publications. Front Matter....Pages i-xvi Front Matter....Pages 1-1 Basic Science of Breast Cancer in Older Patients....Pages 3-19 Tumor Biology and Pathology....Pages 21-35 Clinical Epidemiology and the Impact of Co-Morbidity on Survival....Pages 37-50 Front Matter....Pages 52-52 Comprehensive Geriatric Assessment....Pages 53-63 A Practical Mini-Guide to Comprehensive Geriatric Assessment....Pages 65-74 Impact of the Physiological Effects of Aging on the Pharmacokinetics and Pharmacodynamics of Systemic Breast Cancer Treatment....Pages 75-99 Impact of Hormone Replacement Therapy on Breast Cancer....Pages 101-108 Experiences of a Multidisciplinary Elderly Breast Cancer Clinic: Using the Right Specialists, in the Same Place, with Time....Pages 109-123 Front Matter....Pages 126-126 Mammographic Breast Screening in Elderly Women....Pages 127-142 Primary Endocrine Therapy for the Treatment of Early Breast Cancer in Older Women....Pages 143-164 Peroperative Radiotherapy....Pages 165-181 General and Local Anesthetics....Pages 183-195 The Surgical Management of Breast Cancer in Elderly Women....Pages 197-211 Breast Reconstruction....Pages 213-229 Adjuvant Endocrine Therapy....Pages 231-247 Adjuvant Chemotherapy....Pages 249-262 Adjuvant Radiotherapy....Pages 263-274 Prevention and Treatment of Skeletal Complications....Pages 275-297 Medical Management of Advanced Disease....Pages 299-313 The Use of Chemotherapy in Elderly Cancer Patients: Dose Adjusting, Drug Interactions, and Polypharmacy....Pages 315-330 Front Matter....Pages 332-332 Delayed Presentation of Breast Cancer in Older Women....Pages 333-341 Patient Decision Making....Pages 343-348 Culture, Ethnicity, and Race: Persistent Disparities in Older Women with Breast Cancer....Pages 349-369 Supportive, Palliative and End-of-Life Care for Older Breast Cancer Patients....Pages 371-403 Back Matter....Pages 405-413 I was looking at Mrs T – all 45 kilos of her – with somewhat puzzled thoughts. I had prescribed her capecitabine at very prudent doses, in view of her 91-year-old kidneys and physiology. She had reduced my treatment even further, "because it was making her tired." As a result, she was taking a grand total of 500 mg of capecitabine a day. Yet, her metastatic, ER/PR-negative, Her2-positive breast cancer was undoubtedly responding. Her pain was improving and her chest mass was shrinking, as were her lung metastases... What was the secret of that response? Were Mrs T's kidneys eli- nating even less drug than predicted by her creatinine clearance? Was her sarcopenia altering drug distribution? Was she absorbing more drug than average? Or was her tumor exquisitely sensitive to fluoropyrimidines? "Physicians," said Voltaire, "pour drugs they know little for diseases they know even less into patients they know no- ing about." Medicine has made tremendous progress since the eighteenth century. Yet, there are fields where quite a lot remains to be learned. In developed countries, 25% of breast cancers occur in patients aged 75 years and older. Yet, these patients represent only 4% of the population of traditional clinical trials. That ought to let us wonder how relevant data acquired in patients in their 60s are to a nonagenarian. Fortunately, geriatric oncologists have been stepping up to the task and have gen- ated data to help us to treat such patients. There has been a surge of interest in the topic of how older patients should be treated with various forms of malignancy, with a focus on the management of breast cancer. This group of patients have been neglected in the past, with a failure to recruit them to clinical trials resulting in a lack of evidence on which to base treatment guidelines