Management of Breast Cancer in Older Women
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Management of Breast Cancer in Older Women

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Riccardo A. Audisio
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"There has been a recent surge of interest in the general topic of how older patients should be treated with various forms of malignancy, with particular focus on the management of breast cancer. This group of patients has been neglected in the past, with a failure to recruit them to clinical trials resulting in a lack of evidence on which to base treatment guidelines. The co-editors on this title are directly involved in a number of initiatives to address this gap in knowledge, and are thus perfectly placed to invite other expert individuals to author specific chapters in the proposed text."
"Part I: Background and Epidemiology.- Basic Science of Breast Cancer in Older Patients.- Tumor Biology and Pathology.- Clinical Epidemiology and the Impact of Co-Morbidity on Survival.- Part II: Special Considerations in the Management of Older Women.- Comprehensive Geriatric Assessment.- A Practical Mini-Guide to Comprehensive Geriatric Assessment.- Physiological Effects of Aging on Systemic Treatment: Impact on Pharmacokinetics and Pharmacodynamics of Breast Cancer Medication.- Impact of Hormone Replacement Therapy on Breast Cancer.- Experiences of a Multidisciplinary Elderly Breast Cancer Clinic: Using the Right Specialists, in the Same Place, with Time.- Part III: Therapeutics.- Mammographic Breast Screening in the Elderly.- Primary Endocrine Therapy for the Treatment of Early Breast Cancer in Older Women.- Per-operative Radiotherapy.- General and Local Anesthetics.- The Surgical Management of Breast Cancer in Elderly Women.- Breast Reconstruction.- Adjuvant Endocrine Therapy.- Adjuvant Chemotherapy.- Adjuvant Radiotherapy.- Prevention and Treatment of Skeletal Complications.- Medical Management of Advanced Diseases.- The Use of Chemotherapy in Elderly Cancer Patients: Dose Adjusting, Drug Interactions and Polypharmacy.- Part IV: Psychosocial Considerations.- Delayed Presentation of Breast Cancer in Older Women.- Patient Decision Making.- Culture, Ethnicity and Race: Persistent Disparities in Older Women with Breast Cancer.- Supportive, Palliative Care and End of life Care for Older Breast Cancer Patients."
I was looking at Mrs T all 45 kilos of her with somewhat puzzled thoughts. I had prescribed her capecitabine at very prudent doses, in view of her 91-year-old kidneys and physiology. She had reduced my treatment even further, because it was making her tired. As a result, she was taking a grand total of 500 mg of capecitabine a day. Yet, her metastatic, ER/PR-negative, Her2-positive breast cancer was undoubtedly responding. Her pain was improving and her chest mass was shrinking, as were her lung metastases What was the secret of that response? Were Mrs Ts kidneys eli- nating even less drug than predicted by her creatinine clearance? Was her sarcopenia altering drug distribution? Was she absorbing more drug than average? Or was her tumor exquisitely sensitive to fluoropyrimidines? Physicians, said Voltaire, pour drugs they know little for diseases they know even less into patients they know no- ing about. Medicine has made tremendous progress since the eighteenth century. Yet, there are fields where quite a lot remains to be learned. In developed countries, 25% of breast cancers occur in patients aged 75 years and older. Yet, these patients represent only 4% of the population of traditional clinical trials. That ought to let us wonder how relevant data acquired in patients in their 60s are to a nonagenarian. Fortunately, geriatric oncologists have been stepping up to the task and have gen- ated data to help us to treat such patients.

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