older women not benefiting as much - I wonder????

[Jean]

http://www.medicalnewstoday.com/articles/237392.php

After reading this article I was wondering if some of the reasons are that older women rely more on their doctors opinion and do not question options as much?

Do they get 2nd and 3rd opinions?

Do they have computer skills to do research and gain more knowledge about the disease?

Does this age group have a younger support group or are many on their own such as children who have moved states away and are busy raising their own families?

During the time of this study how many of the women in this age group were stage 1, Her2 and not given herceptin?

I can't help but consider that often times this age group is forgotten just because they are old. I have a 96 yr. old Aunt in a nursing home that I visit each week and I will share with you that most of the elders (not as old as my Aunt) either do not have family or they are forgotten.

Your 2 cents?

[Hopeful]

Jean, it looks like our newest Board member falls into that age group: http://her2support.org/vbulletin/sho...336#post261336

It might be interesting to find out what her doctors recommended as her course of tx.

Hopeful

[NanaJoni]

I have several friends and family members who decided, due to their advanced age, not to pursue treatment (chemo or radiation) after a breast cancer diagnosis. I wonder if those who refused treatment were given a separate status in these statistics.

[LoisAnn]

Hi Jean & All,
Don't have a treatment plan yet. I was first told that I might need to take Pill Type chemo, but specific drug was not mentioned. The surgeon's nurse told my daughter she thought my age was a typo, and that they treat elderly women based pretty much exclusively on health status - age is not a significant determinant at their office.

Have talked with friend's who have BC too. My daughter is helping me with online research. My good friend, also in her 80's, has extensive metastatic disease but didn't even know what kind of BC it was when I asked. She originally was diagnosed 30 years ago, disease returned some years ago. She has treated it aggressively. The last IV chemo treatments caused her to lose feeling in her hands & feet. She said it has eaten through her skin, but she had been out raking leaves that day when I called her last week.

Some of my friends have lost their children to BC. We live in a city with top-notch medical care available. My Dr. is also a Prof. at the Medical College here. She was highly recommended.

Living in a large retirement community, I have some friends here who don't even know what the meds they take are for. I guess they just don't question their Doctors, or don't want to know. I question everything I'm prescribed and get information by reading up on everything. Even at the hospital they had to tell me specifically what every drug was for.

This am I'm heading out to mass after a good breakfast.

[ElaineM]

Maybe you are on to something Jean.
I noticed my older friends do not question their doctors.
They do not ask many questions. They just accept whatever the doctor tells them to do. The view of the doctor and patient relationship was different when they were brought up. They were taught not to question their doctors, because they believed their doctors knew everything.
I on the other hand am a doctor's worst nightmare. My view is that we discuss everything and work as a team to take care of whatever problems pop up. I do not agree to anything unless we discuss it like two partners.
I do my own research after asking for literature from the doctors office on whatever subject we are discussing. I also get copies of all my test results and sometimes get other medical opinions on the subject.
I even did that when I ended up in the ER with a broken hip !!!!!!!!!! I did not sign the consent for for a doctor I was not familar with to operate on me unless he sat down and talked to me and answered my questions first.

[Jackie07]

My late Mother-in-law's high school teacher, also the wife of my In-laws' late pastor, had breast cancer surgery and treatment a few years before she turned 90. She still lives at home by herself - with frequent visits from her daughter and neighbors.

I grew suspecious everytime I read something that appears to be an attempt to justify reduced treatment options/length of time... These things need to be decided by doctors and their patients/patients' family. The wording of the result of a study can give complete different impression: "Older women still benefit..."

One observation - could the 'no benefit' observation caused partly by the better survival of women younger than 65? Could it be because that many bc survivors at the younger age group lived past 65 - thus cause the number of the older women group to appear as 'no change'?

[Jean]

Elaine,
I have to agree. While older bc patients certainly have to be considered at a higher risk for treatments I had to wonder if dx Her2 ...at the very least why not treat with Herceptin (in the case that the chemo maybe too difficult).

Recently my Aunt had gotten a severe cold. When I went in to visit (and note she is in a good care center) yet they were rather dismissive of her situation. My Aunt was not taking her meds by mouth. So I insisted they move her to the hospital and she was put on IV antibiotic. In a few days she was herself. The staff dr. had an attitude well she is 96...I was very shocked with the attitude.
Then reading this article it was another peek into that attitude. Then along with the features that many older patents (such as my Aunt) may not have family or friends to assist and help make quality choices. It is of concern.
I certainly realize that as one ages quality along with care is vital but I have to admit there is an attitude of, well they are old !
I was annoyed that the dr. at the care center would more or less not be concerned that she would only become worse if not taken oral meds. While bc is a huge leap from a bad cold dx. it is the attitude that I believe goes with treatment that I am thinking is wrong.

LoisAnn you sound like a strong wise women. So happy that your daughter is involved with your treatment. Most important you are working with cutting edge dr. which always proves to be a strong advantage.

Jackie interesting concept: There is still much data to be considered.

Best Wishes and Blessing to all.
Jean

[LoisAnn]

This study, Diagnosis and Treatment of Breast Cancer in the Elderly, Chris E. Holmes MD, PhD; Hyman B. Muss, MD, (CA Cancer J Clin 2003;53:227–244.) states, "As the population of the United States ages, women over the age of 65 have become a prominent cohort in the breast cancer population, with approximately 50% of all new breast cancers occurring in women aged 65 years and older."

Specifically, "Christman, et al.68 have found that elderly women in overall good health are able to tolerate chemotherapy as well as their younger counterparts. These same women also derive benefit from combination chemotherapy with similar response rates and overall survival as their younger counterparts."

It also said that "co-morbidity," or having other serious health conditions is of particular concern with treating elderly women, but I suppose that really isn't any different than treating anyone who is younger & has other serious health problems. Its just more likely that elderly women will have other health conditions.

[AlaskaAngel]

Hi LoisAnn. A friend of mine in her 80's in Seattle is also very fit and active, and is dealing with her third bout of bc spread over several decades. I do not have her specifics of diagnosis so I don't know if she is HER2 positive but she has elected to put off her treatment until she gets back from a 2 or 3 week trip to South America, where one of her children has been working.

In considering whether chemo is equally helpful in your age group as it is to those in younger populations, I think it is likely that the numbers in part reflect not so much that chemo is effective for older women, but that breast cancer is generally slower-growing in the elderly population than it is in the younger population, related to most older women being menopausal (and more completely menopausal) than younger women. With treatment, younger women often have trouble staying menopausal despite treatment, which lowers the effectiveness of their treatment in relation to your age group.

Nice to meet you!

-AlaskaAngel

[Rich66]

Although I have high sensitivity to and awareness of age bias in medicine, I will add there may be immune system considerations in all this..evidenced by FDA recommending double the dose for something as basic as a flu shot for older patients.