Systemic treatment for specific medical situations

Abstract

In the last few centuries, medicine progresses have ensured an increasingly longer life expectancy, even in patients affected by chronic diseases, whose proportion is increasing. Moreover, recent advances in the field of oncology have contributed to significantly improve disease outcomes for most type of cancers; therefore the proportion of other malignancy survivors newly diagnosed with breast cancer is also increasing. Aging is a major risk factor for breast cancer, and older women are a growing segment of the population in western countries; therefore during the coming decades, they will represent an increased cohort of patients with breast cancer. Along with evidence from the literature, when dealing with elderly breast cancer patients, oncologists need to consider functional status, social support, patient preference, comorbidities, and life expectancy, weighing the risks and benefits of all therapeutic options to select optimal treatment. No absolute age limit was identified for the use of standard chemotherapy; rather, the use of such treatment should depend on disease characteristics, comorbidity, life expectancy, and patient preference. In general, standard treatments should be offered to “fit” elderly patients irrespective of age. However, for elderly or frail patients, single-agent schedules may be preferable. Patients surviving after a first tumor diagnosis and newly diagnosed with breast cancer present some treatment issues, mostly related to cumulative toxicities of treatments, which should be carefully taken into consideration.