Perspectives and Attitudes on the Use of Adjuvant Chemotherapy and Trastuzumab in Older Adults with HER-2(+) Breast Cancer: A Survey of Oncologists

Background. Substantial evidence supports the use of adjuvant trastuzumab with chemotherapy for patients with human epidermal growth factor receptor (HER)-2(+) breast cancer; however, a lesser amount of data is available to guide use of this therapy in older patients and in those with significant medical comorbidities. The goal of the current study was to understand how patient age and health status impact oncologists' decisions to recommend adjuvant therapy in older women with HER-2(+) breast cancer. Methods. Medical oncologists (n = 151) participated in an online survey regarding treatment recommendations for a hypothetical patient of varying age and health status with tumor stage 2, nodal stage 2, estrogen receptor-negative, HER-2(+) breast cancer. Survey respondents recommended either chemotherapy plus trastuzumab, chemotherapy alone, trastuzumab alone, or no therapy. The effect of age and health status on therapeutic recommendations was assessed. Findings. As the hypothetical patient's age increased or health status deteriorated, oncologists were less likely to recommend a combination of chemotherapy plus trastuzumab. In contrast, oncologists were more likely to recommend either trastuzumab alone or no therapy for patients with advanced age and deteriorating health status. Chemotherapy alone was recommended by only 7.5% of respondents, on average. Interpretation. With limited evidence-based data for the treatment of older women with early-stage HER-2(+) breast cancer, medical oncologists recommend a diverse array of therapeutic approaches. With increasing age and declining health status they were less likely to recommend chemotherapy plus trastuzumab and more likely to recommend single-agent trastuzumab or no therapy. The Oncologist 2009; 14: 883-890