Less aggressive therapy may be appropriate for older adults with early breast cancer. Decisions should be made considering patient preferences and with the help of clinicians skilled at communicating.
CHICAGO — By definition, all clinical care is — or should be — patient-centered care, and that is especially true for older women with early stage"Older women need to be informed of the benefits and risks of their treatment options, including the option of omitting a treatment," said Mara Schonberg, MD, MPH, from the division of general medicine and primary care at Beth Israel Deaconess Medical Center in Boston, Massachusetts.
"It is really important that we think about all these decisions that older women face in their preference-sensitive decisions and that we include them in the decision-making, probably even starting at the time ofDoctor–patient shared decision making improves patient care by helping the patients understand the best available evidence on the risks and benefits of specific choices and their alternatives, Schonberg said.
"How do we de-escalate the extent of surgery, the extent of morbidity that we are imparting on our patients with surgery but still maximizing and preserving oncological outcomes?" she asked.receptor positive, HER2-negative disease is the majority biomarker profile. "Just at baseline, we know that mastectomy is a harder operation, it's a harder recovery. You may be incorporating additional surgery such as reconstructive surgery, so breast-conserving surgery is always considered less invasive, less morbid," she said.
Moving forward, the debate in radiation oncology is likely to focus on the option of ultra hypofractionation vs no radiation, she added. Radiation may also be deferred in many older patients who may benefit from endocrine therapy alone and in those who have a very early stage and less aggressive tumor type.Etienne GC Brain, PhD, from the department of medical oncology at the Curie Institute in Paris and Saint-Cloud, France, reviewed evidence regarding systemic therapy in older patients with high-risk breast cancers.
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