Overview

Breast cancer treatment in the elderly is a management challenge. Of the approximately 200,000 new breast cancer cases diagnosed each year in the United States, approximately 50% occur in women over age 65.^1,2 Approximately 60% of the 40,000 annual breast cancer deaths occur in women over age 65.³

Current and available treatment modalities include localized therapies such as surgery and radiation as well as systemic therapies such as chemotherapy and hormonal therapy. Approximately 75% of postmenopausal breast cancer patients have estrogen-dependent tumors.⁴ Study data on women who started tamoxifen, indicate that one-third failed to complete the recommended 5-year course, with the highest rates of failure among the elderly. Failure to adhere to tamoxifen therapy has been attributed to side effects and poly-pharmacy.⁵ Other factors that have been attributed to adherence failure are dysphagia, economic considerations, cognitive impairment and the patient's own belief that they have "lived long enough."⁶

Medication adherence is an important part of therapeutic outcome. In the elderly, dysphagia and other oral complications such as xerostomia and oral mucositis may be common and can affect medication adherence, since the ability to chew and swallow both food and pills may be compromised. This program will examine the causes and care of patients with dysphagia and other common oral complications. The program will also look at treatment options, including soluble forms of hormonal therapy, which may positively affect patient adherence and ultimately patient outcomes.