Special aspects of breast cancer surgery in the elderly

2014 ◽  
Vol 155 (24) ◽  
pp. 931-938
Author(s):  
Zoltán Mátrai ◽  
Csaba Polgár ◽  
Eszter Kovács ◽  
Alexandra Bartal ◽  
Gábor Rubovszky ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Clinical Trials ◽  
Elderly Patients ◽  
Treatment Plan ◽  
Performance Status ◽  
The Elderly ◽  
Breast Cancer Surgery ◽  
Axillary Staging ◽  
Individual Treatment ◽  
Axillary Lymphadenectomy

Due to the aging population of Western countries and the high-quality health care system, breast cancer in the eldelry generally affects women of good or satisfactory performance status pursuing active lifestyle. Over the last decade, it became evident that, in contrast to previous dogmas, age alone cannot be the contraindication to standard oncological treatment, and adequate multidisciplinary therapy aiming full recovery rather than compromise treatment is required. A number of specific aspects needs to be taken into account regarding surgery, such as life expectancy, co-morbidities, individual mobility, mental and emotional status as well as family background, which may result in changes to the individual treatment plan. Objective evaluation of the above mentioned parameters necessitates a close co-operation of professions. Interestingly, the evidence-based protocols of modern oncology often originate from the generalizations of results from clinical trials representing younger population, due to the typical underrepresentation of elderly patients in clinical studies. Clinical trials should be extended to elderly patients as well or should specifically aim this patient population. The authors of the present paper review the special oncological and reconstructive surgical aspects of breast cancer in the elderly, such as breast conserving surgery versus mastectomia, sentinel lymph node biopsy, axillary lymphadenectomy or the omission of surgery in axillary staging, and questions regarding implant based and autologous reconstructive techniques. Orv. Hetil., 2014, 155(24), 931–938.

Clinical and pathological characteristics of elderly colorectal cancer patients over 70 years old and comparison with patients under 50 years old.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14174-e14174
Author(s):  
Betul Erismis ◽  
Nadire Kucukoztas ◽  
Samed Rahatli ◽  
Selim Yalcin ◽  
Omer Dizdar ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Elderly Patients ◽  
Cancer Patients ◽  
Systemic Disease ◽  
Performance Status ◽  
The Elderly ◽  
University Hospital ◽  
Individual Treatment ◽  
Pathological Characteristics ◽  
Colorectal Cancer Patients

e14174 Background: Incidence of colon cancer increases with age and generally is diagnosed at the age of between 60-75. Because of comorbidities in elderly patients who are older 70 years of age, lower doses of adjuvant or metastatic therapy is given them or the other option can be the chemotherapeutics which had less side effects. Methods: We aim to identify clinical and pathological characteristics of elderly colorectal cancer patients over 70 years of age who were followed at Baskent University Hospital and compare with CRC patients under the 50 years of age. Results: 182 CRC patients were assigned to the study who were followed between 1998-2011. We classified the patients into two categories according to the age. 91 participants were over 70 years of age and 91 participants were under 50 years of age. There were no significant differences between two groups for gender and percentage of patients having surgery (p=0.65/0.732). History of having systemic disease was significantly higher in the elderly group (p<0.001). Adjvuvant chemotherapy was given to the 38 (53.5%) patients aged over 70 and 66 (91.7%) patients aged under 50 (p<0.001). We compared the both groups for progression free and overall survival time for all stages. However, there were no statistically significant differences between two groups. Conclusions: Our study confirms that elderly CRC patients get benefit from the adjuvant chemotherapy treatment as the same as patients under 50 years of age. Therefore, physcians should consider about performance status and systemic disease in elderly patients and give an individual treatment to them.

scholarly journals Special considerations of breast cancer management in the elderly

2020 ◽  
pp. BMT46
Author(s):  
Lauren F Cornell ◽  
Sarah A Mclaughlin ◽  
Sandhya Pruthi ◽  
Dawn M Mussallem
Keyword(s):  
Breast Cancer ◽  
Clinical Trials ◽  
Elderly Patients ◽  
Management Strategies ◽  
The Elderly ◽  
Evidence Based ◽  
Limited Evidence ◽  
Cancer Management ◽  
Breast Cancer Management ◽  
Evidence Based Guidelines

There are increasing numbers of elderly patients diagnosed with breast cancer. These patients are under-represented in available clinical trials, and as such, there are limited evidence-based guidelines for treatment in this population. Elderly patients have unique needs and management strategies should be tailored accordingly. This article reviews available literature regarding breast cancer management and special considerations in elderly patients.

Breast Cancer in the Elderly

2007 ◽  
Vol 25 (14) ◽  
pp. 1882-1890 ◽  
Author(s):  
Diana Crivellari ◽  
Matti Aapro ◽  
Robert Leonard ◽  
Gunter von Minckwitz ◽  
Etienne Brain ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Clinical Trials ◽  
Life Expectancy ◽  
Cancer Patients ◽  
Disease Free Survival ◽  
Cost Benefit ◽  
The Elderly ◽  
Breast Cancer Patients ◽  
Younger Women ◽  
Based Medicine

Screening and adjuvant postoperative therapies have increased survival among women with breast cancer. These tools are seldom applied in elderly patients, although the usually reported incidence of breast cancer is close to 50% in women 65 years or older, reaching 47% after 70 years in the updated Surveillance, Epidemiology, and End Results (SEER) database. Elderly breast cancer patients, even if in good medical health, were frequently excluded from adjuvant clinical trials. Women age 70 years who are fit actually have a median life expectancy of 15.5 years, ie, half of them will live much longer and will remain exposed for enough time to the potentially preventable risks of a relapse and specific death. In the last few years, a new concern about this issue has developed. Treatment now faces two major end points, as in younger women: to improve disease-free survival in the early stages, and to palliate symptoms in advanced disease. However, in both settings, the absolute benefit of treatment is critical because protecting quality of life and all its related aspects (especially functional status and independence), is crucial in older persons who have more limited life expectancy. Furthermore, the new hormonal compounds (aromatase inhibitors) and chemotherapeutic drugs (capecitabine, liposomal doxorubicin), are potentially less toxic than and equally as effective as older more established therapies. These new treatments bring new challenges including higher cost, and defining their benefit in elderly breast cancer must include an analysis of the cost/benefit ratio. These issues emphasize the urgent need to develop and support clinical trials for this older population of breast cancer patients both in the adjuvant and metastatic settings, a move that will take us from a prejudiced, age-based medicine to an evidence-based medicine.

scholarly journals Treatment with CPAP in Elderly Patients with Obstructive Sleep Apnoea

2020 ◽  
Vol 9 (2) ◽  
pp. 546 ◽  
Author(s):  
Tomas Posadas ◽  
Grace Oscullo ◽  
Enrique Zaldívar ◽  
Alberto Garcia-Ortega ◽  
José Daniel Gómez-Olivas ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Elderly Patients ◽  
Obstructive Sleep Apnoea ◽  
The Elderly ◽  
Sleep Apnoea ◽  
Age Group ◽  
Obstructive Sleep ◽  
Receive Treatment ◽  
Therapeutic Tools

The population pyramid is changing as a result of the ever-increasing life expectancy, which makes it crucial to acquire an in-depth understanding of the diseases that most often affect the elderly. Obstructive sleep apnoea (OSA) affects 15%–20% of the population aged over 65 years. Despite this prevalence, there have been very few specific studies on the management of OSA in this age group, even though over 60% of the patients aged over 65-70 years who attend sleep units with suspicion of OSA receive treatment with continuous positive airway pressure (CPAP), on the basis of an extrapolation of the positive results achieved by CPAP in clinical trials involving middle-aged males. However, the latter’s form of presentation, evolution and, probably, prognosis comparing with OSA are not the same as those of elderly patients. Recent clinical trials performed on an exclusive series of elderly patients have shed light on the possible role of CPAP treatment in elderly patients with OSA, but there are still many questions that need to be answered. The physiological increase in the number of sleep-related disorders with the passing of years, and the lack of validated diagnostic and therapeutic tools for this age group are probably the greatest obstacles to define, diagnose and treat OSA in the elderly.

scholarly journals COT-16 INDICATION OF SYSTEMIC THERAPY FOR ELDER PATIENTS WITH BRAIN TUMORS: A SYSTEMATIC REVIEW AND PERSPECTIVE

2019 ◽  
Vol 1 (Supplement_2) ◽  
pp. ii43-ii43
Author(s):  
Yoko Nakasu ◽  
Koichi Mitsuya ◽  
Satoshi Nakasu ◽  
Kazuhiko Nozaki
Keyword(s):  
Elderly Patients ◽  
Systemic Therapy ◽  
Brain Tumours ◽  
Performance Status ◽  
The Elderly ◽  
Assessment Tools ◽  
Geriatric Population ◽  
Pubmed Database ◽  
Group 2 ◽  
Definition Of

Abstract BACKGROUND Little is known about indications and outcome prediction of systemic therapy for elderly patients with brain tumours. Clinical conditions of individuals are heterogenous from healthy to frail or diseased,moreover,are often reversible. METHOD We retrieved the literature of brain tumour,systemic therapy,chemotherapy,immunotherapy,in randomized controlled trials (RCTs) and reviews on PubMed database from 2008 to 2018. RESULTS 1) Definition of elderly by age in years: Depending on each protocol,the definition is arbitrary. Patients older than 60 or 70 years are usually in the elderly group. 2) Systemic evaluation: Performance status (PS) and visceral function are not sufficient to assess elderly patients. Assessment tools specifically developed for the geriatric population are recommended to evaluate individual patients. 3) Effects and toxicity of systemic therapy: Only a few RCT showed no inferiority of outcome in patients older than 60 or 65 years. There are only few evidences about the senile fragility of blood-brain barrier or distribution of drugs in the elderly brain. Molecular subtyping of brain tumours might predict the effects and toxicities of therapies for elderly patients. CONCLUSION Feasibility of modern systemic therapies are not well studied for elderly patients with brain tumours. Clinical condition varies in individual elderly patients. We need prospective studies of systemic therapy in elderly patients based on an eligibility with not only chronologic age but comprehensive geriatric assessments.

scholarly journals Psychological Aspects of Breast Reconstruction after Breast Cancer

Breast Care ◽  
2019 ◽  
Vol 14 (5) ◽  
pp. 298-301
Author(s):  
Anna Pittermann ◽  
Christine Radtke
Keyword(s):  
Breast Cancer ◽  
Treatment Plan ◽  
Breast Cancer Mortality ◽  
Psychological Aspects ◽  
Breast Cancer Surgery ◽  
Psychosocial Needs ◽  
Reconstructive Procedures ◽  
Affected Woman ◽  
Close Family ◽  
Type Of Surgery

Even though breast cancer mortality is declining, the diagnosis still poses a huge threat for the affected woman and her close family. Breast cancer surgery, which often includes reconstructive procedures, can help restoring a satisfactory body image. The decision on the type of surgery should always be made together with the patient and should focus on her psychosocial needs. This review describes the psychological aspects of breast cancer for the patient and her social environment and offers ideas for a patient-oriented treatment plan.

scholarly journals Recent Advances in the Use of Metformin: Can Treating Diabetes Prevent Breast Cancer?

2015 ◽  
Vol 2015 ◽  
pp. 1-13 ◽  
Author(s):  
Diana Hatoum ◽  
Eileen M. McGowan
Keyword(s):  
Breast Cancer ◽  
Clinical Trials ◽  
Clinical Studies ◽  
Clinical Trial Data ◽  
The Elderly ◽  
Diabetic Patients ◽  
Positive Trend ◽  
Patients With Diabetes ◽  
Meta Analyses

There is substantial epidemiological evidence pointing to an increased incidence of breast cancer and morbidity in obese, prediabetic, and diabetic patients.In vitrostudies strongly support metformin, a diabetic medication, in breast cancer therapy. Although metformin has been heralded as an exciting new breast cancer treatment, the principal consideration is whether metformin can be used as a generic treatment for all breast cancer types. Importantly, will metformin be useful as an inexpensive therapy for patients with comorbidity of diabetes and breast cancer? In general, meta-analyses of clinical trial data from retrospective studies in which metformin treatment has been used for patients with diabetes and breast cancer have a positive trend; nevertheless, the supporting clinical data outcomes remain inconclusive. The heterogeneity of breast cancer, confounded by comorbidity of disease in the elderly population, makes it difficult to determine the actual benefits of metformin therapy. Despite the questionable evidence available from observational clinical studies and meta-analyses, randomized phases I–III clinical trials are ongoing to test the efficacy of metformin for breast cancer. This special issue review will focus on recent research, highlightingin vitroresearch and retrospective observational clinical studies and current clinical trials on metformin action in breast cancer.

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