Article

Special Considerations in the Management of Older Adult Patients With Metastatic Breast Cancer

Diana Donovan

aged, metastasis, breast cancer care, management, adult cancer survivors, clinical trials
CJON 2013, 17(1), 41-48. DOI: 10.1188/13.CJON.S1.41-48

A majority of new cancer cases occur in older adults (aged 65 years and older); however, older adult patients often are underrepresented in clinical trials. Because of this, sufficient evidence is lacking for the creation of treatment guidelines for older adult patients. Evidence has shown that many therapeutic agents are effective in both older and younger adult patients. Although efficacy outcomes may be similar, safety profiles may differ by age because of inherent differences in drug metabolism or other reasons. The underrepresentation of older adult patients in clinical trials is explored in this article, along with the current recommendations for treating older adult patients with metastatic breast cancer (MBC). In addition, current evidence from clinical trials and subanalyses of older adult patients with MBC are discussed. Finally, nursing considerations for the management of older adult patients with MBC are provided.

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    References

    Aapro, M., Tjulandin, S., Bhar, P., & Gradishar, W. (2011). Weekly nab-paclitaxel is safe and effective in ≥ 65 years old patients with metastatic breast cancer: A post-hoc analysis. Breast, 20, 468-474. doi:10.1016/j.breast.2011.07.005
    American Cancer Society. (2012a). Breast cancer facts and figures 2011-2012. Atlanta, GA: Author.
    American Cancer Society. (2012b). Cancer facts and figures 2012. Atlanta, GA: Author.
    Aymanns, C., Keller, F., Maus, S., Hartman, B., & Czock, D. (2010). Review on pharmacokinetics and pharmacodynamics and the aging kidney. Clinical Journal of the American Society of Nephrology, 5, 314-327. doi:10.2215/CJN.03960609
    Bastiaannet, E., Liefers, G.J., de Craen, A.J.M., Kuppen, P.J.K., van de Water, W., Portielje, J.E., … Westendorp, R.G. (2010). Breast cancer in older adults compared to younger patients in the Netherlands: Stage at diagnosis, treatment, and survival in 127,805 unselected patients. Breast Cancer Research and Treatment, 124, 801-807. doi:10.1007/s10549-010-0898-8
    Bernabei, R., Venturiero, V., Tarsitani, P., & Gambassi, G. (2000). The comprehensive geriatric assessment: When, where, how. Critical Reviews in Oncology/Hematology, 33, 45-56. doi:10.10 16/S1040-8428(99)00048-7
    Beuselinck, B., Wildiers, H., Wynendaele, W., Dirix, L., Kains, J.P., & Paridaens, R. (2010). Weekly paclitaxel versus weekly docetaxel in older adult or frail patients with metastatic breast carcinoma: A randomized phase II study of the Belgian Society of Medical Oncology. Critical Reviews in Oncology/Hematology, 75, 70-77. doi:10.1016/j.critrevonc.2009.07.001
    Biganzoli, L., Wildiers, H., Oakman, C., Marotti, L., Loibl, S., Kunkler, I., … Audisio, R. (2012). Management of older adult patients with breast cancer: Updated recommendations of the International Society of Geriatric Oncology (SIOG) and European Society of Breast Cancer Specialists (EUSOMA). Lancet Oncology, 13, E148-E160. doi:10.1016/S1470-2045(11)70383-7
    Brunello, A., Monfardini, S., Crivellari, D., Puglisi, F., Nascimben, O., Scattolin, G., … Basso, U. (2008). Multicenter analysis of activity and safety of trastuzumab plus chemotherapy in advanced breast cancer in older adult women (≥ 70 years) [Abstract 1096]. Journal of Clinical Oncology. Retrieved from http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&… http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&confID=55&abstractID=33834
    Davis, K.L., Iyer, S., & Candrilli, S. (2011). Survival among older adult metastatic breast cancer patients in the United States. Journal of Clinical Oncology, 29(15, Suppl.), E16500.
    Debled, M., Bellera, C., Donamaria, C., & Soubeyran, P. (2011). Chemotherapy treatment for older women with metastatic breast cancer: What is the evidence? Cancer Treatment Reviews, 37, 590-598. doi:10.1016/j.ctrv.2011.04.007
    Del Mastro, L., Perrone, F., Repetto, L., Manzione, L., Zagonel, V., Fratino, L., … Gruppo Italiano di Oncologia Geriatrica (GIOGer). (2005). Weekly paclitaxel as first-line chemotherapy in older adult advanced breast cancer patients: A phase II study of the Gruppo Italiano di Oncologia Geriatrica (GIOGer). Annals of Oncology, 16, 253-258. doi:10.1093/annonc/mdi056
    D'hondt, R., Paridaens, R., Wildiers, H., Pauwelyn, K., Thomas, J., Dumez, H., & Van Oosterom, A.T. (2004). Safety and efficacy of weekly docetaxel in frail and/or older adult patients with metastatic breast cancer: A phase II study. Anticancer Drugs, 15, 341-346.
    Dong, N., Wang, M., Li, H., Cui, Y., & Guo, Q. (2012). Gemcitabine in combination with vinorelbine in older adult patients with anthracycline-and taxane-pretreated metastatic breast cancer. Cancer Chemotherapy and Pharmacology, 69, 1315-1322. doi:10.1007/s00280-012-1830-1
    Extermann, M. (2006). Interaction between comorbidity and cancer. Cancer Control, 14, 13-22.
    Gillespie, T.W. (2005). Implementation of the NCCN Practice Guidelines: Anemia and neutropenia. Advanced Studies in Nursing, 3, 300-309.
    GlaxoSmithKline. (2012). Tykerb® (lapatinib) [Prescribing information]. Retrieved from http://us.gsk.com/products/assets/us_tykerb.pdf
    Goodwin, J.S. (1989). Knowledge about aging among providers. Journal of Aging and Health, 1, 234-243.
    Gradishar, W.J., Krasnojon, D., Cheporov, S., Makhson, A.N., Manikhas, G.M., Clawson, A., & Bhar, P. (2009). Significantly longer progression-free survival with nab-paclitaxel compared with docetaxel as first-line therapy for metastatic breast cancer. Journal of Clinical Oncology, 27, 3611-3619. doi:10.1200/JCO.2008.18.5397
    Gradishar, W.J., Tjulandin, S., Davidson, N., Shaw, H., Desai, N., Bhar, P., … O'Shaughnessy, J. (2005). Phase III trial of nanoparticle albumin-bound paclitaxel compared with polyethylated castor oil-based paclitaxel in women with breast cancer. Journal of Clinical Oncology, 23, 7794-7803. doi:10.1200/JCO.2005.04.937
    Greenfield, S., Blanco, D.M., Elashoff, R.M., & Ganz, P.A. (1987). Patterns of care related to age of breast cancer patients. JAMA, 257, 2766-2770.
    Hainsworth, J.D., Burris, H.A., 3rd., Yardley, D.A., Bradof, J.E., Grimaldi, M., Kalman, L.A., … Greco, F.A. (2001). Weekly docetaxel in the treatment of older adult patients with advanced breast cancer: A Minnie Pearl Cancer Research Network phase II trial. Journal of Clinical Oncology, 19, 3500-3505.
    Herr, K.A., & Mobily, P.R. (1991). Complexities of pain assessment in the older adult. Clinical considerations. Journal of Gerontology Nursing, 17, 12-19.
    Hess, D., Koberle, D., Thurlimann, B., Pagani, O., Schonenberger, A., Mattmann, S., … Swiss Group for Clinical Cancer Research. (2007). Capecitabine and vinorelbine as first-line treatment in older adult patients (≥ 65 years) with metastatic breast cancer. A phase II trial (SAKK 25/99). Oncology, 73, 228-237.
    Howlader, N., Noone, A.M., Krapcho, M., Neyman, N., Aminou, R., Altekruse, S.F., … Cronin, K.A. (Eds.). (2012). SEER cancer statistics review, 1975-2009 (Vintage 2009 populations). Retrieved from http://seer.cancer.gov/csr/1975_2009_pops09/
    Kornblith, A.B., Kemeny, M., Peterson, B.L., Wheeler, J., Crawford, J., Bartlett, N., … Cancer and Leukemia Group B. (2002). Survey of oncologists' perceptions of barriers to accrual of older patients with breast carcinoma to clinical trials. Cancer, 95, 989-996. doi:10.1002/cncr.10792
    Le Couteur, D.G., & McLean, A.J. (1998). The aging liver: Drug clearance and an oxygen diffusion barrier hypothesis. Clinical Pharmacokinetics, 34, 359-373.
    Lickley, H.L. (1997). Primary breast cancer in the older adult. Canadian Journal of Surgery, 40, 341-351.
    Manders, K., van de Poll-Franse, L.V., Creemers, G.J., Vreugdenhil, G., van der Sangen, M.J.C., Nieuwenhuijzen, G.A.P., … Voogd, A.C. (2006). Clinical management of women with metastatic breast cancer: A descriptive study according to age group. BioMed Central Cancer, 6, 179.
    McLean, A.J., & Le Couteur, D.G. (2004). Aging biology and geriatric clinical pharmacology. Pharmacological Reviews, 56, 163-184.
    Misra, D., Seo, P.H., & Cohen, H.J. (2004). Aging and cancer. Clinical Advances in Hematology and Oncology, 2, 457-465.
    O'Shaughnessy, J., Miles, D., Gray, R., Dieras, V., Perez, E.A., Zon, R., … Miller, K. (2010). A meta-analysis of overall survival data from three randomized trials of bevacizumab (BV) and first-line chemotherapy as treatment for patients with metastatic breast cancer (MBC) [Abstract 1005]. Journal of Clinical Oncology. Retrieved from http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&… http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&confID=74&abstractID=49471
    Raghavan, D., & Suh, T. (2006). Cancer in the older adult population: The protection racket. Journal of Clinical Oncology, 24, 1795-1796. doi:10.1200/JCO.2005.05.4502
    Sawhney, R., Sehl, M., & Naem, A. (2005). Physiologic aspects of aging: Impact on cancer management and decision making, part I. Cancer Journal, 11, 499-460.
    Sehl, M., Sawhney, R., & Naem, A. (2005). Physiologic aspects of aging: Impact on cancer management and decision making, part II. Cancer Journal, 11, 461-473.
    Siminoff, L.A., Zhang, A., Colabianchi, N., Sturm, C.M., & Shen, Q. (2000). Factors that predict the referral of breast cancer patients onto clinical trials by their surgeons and medical oncologists. Journal of Clinical Oncology, 18, 1203-1211.
    Smith, B.D., Smith, G.L., Hurria, A., Hortobagyi, G.N., & Buchholz, T.A. (2009). Future of cancer incidence in the United States: Burdens upon an aging, changing nation. Journal of Clinical Oncology, 27, 2758-2765. doi:10.1200/JCO.2008.20.8983
    Tahir, M., Robinson, T., & Stotter, A. (2011). How not to neglect the care of older adult breast cancer patients? Breast, 20, 293-296. doi:10.1016/j.breast.2011.03.003
    ten Tije, A.J., Smorenburg, C.H., Seynaeve, C., Sparreboom, A., Schothorst, K.L., Kerkhofs, L.G., … Verweij, J. (2004). Weekly paclitaxel as first-line chemotherapy for older adult patients with metastatic breast cancer. A multicentre phase II trial. European Journal of Cancer, 40, 352-357. doi:10.1016/j.ejca.2003 .08.013
    Wildiers, H., Kunkler, I., Biganzoli, L., Fracheboud, J., Vlastos, G., Bernard-Marty, C., … International Society of Geriatric Oncology. (2007). Management of breast cancer in older adult individuals: Recommendations of the International Society of Geriatric Oncology. Lancet Oncology, 8, 1101-1115. doi:10.1016/S1470-2045(07)70378-9
    Yancik, R., Wesley, M.N., Ries, L.A., Havlik, R.J., Edwards B.K., & Yates, J.W. (2001). Effect of age and comorbidity in postmenopausal breast cancer patients aged 55 years and older. JAMA, 285, 885-892. doi:10.1001/jama.285.7.885
    Zoli, M., Magalotti, D., Bianchi, G., Gueli, C., Orlandini, C., Grimaldi, M., & Marchesini, G. (1999). Total and functional hepatic blood flow decrease in parallel with ageing. Age and Ageing, 28, 29-33. doi:10.1093/ageing/28.1.29