The geriatric oncologist spoke about the differences in treating older women and younger women with triple-negative breast cancer.
Enrique Soto Perez de Celis, MD, MSc, geriatric oncologist and researcher in the department of geriatrics at the Instituto Nacional de Ciencias MÃ©dicas y NutriciÃ³n Salvador ZubirÃ¡n in Mexico City, discussed his presentation on treating older women with triple negative breast cancer and the extra considerations when caring for this population at the 37th Annual Miami Breast Cancer Conference, held March 5-8, 2020 in Miami, Florida.
I think that the take home message is that when treating an older woman with triple negative breast cancer, an oncologist needs to do a series of steps that are different from when you are treating a younger woman. First, you have to do a geriatric assessment, you know, for patients now it’s guideline recommended. So, ASCO has a geriatric oncology guideline that recommends exactly what tools to use and that’s a very useful thing for a clinical practice. You have to calculate the patient’s life expectancy without cancer, because these patients have competing risk, other comorbidities, and so probably the benefits of our treatments are not going to be appropriate for a patient who has a very limited life expectancy due to other diseases.
Then, you have to assess the risks and benefits of treatment and there are several tools that can be utilized to predict chemotherapy toxicity in older women. And finally, you have to align these risks and benefits with patient preferences. Older adults not necessarily view prolonging survival as long as possible the most important outcome, there are other outcomes which older adults might value more such as maintaining their independence, maintaining their cognition, or avoiding symptoms and taking that into account when making decisions that give incremental gains is always very important.
So, after doing all that, you can actually have a discussion with the patient in which the decision is reassured, and patient centered.