Dr Talcott on Treatment De-Escalation in Elderly Patients With Breast Cancer

Wesley J. Talcott, MD, MBA, radiation oncologist, Northwell Health, discusses the importance of de-escalating therapy in patients with breast cancer, highlighting use of personalized treatment approaches.

In the field of oncology, the primary objective of treating oncologists is to consider the possibility of de-escalating treatment when feasible while still achieving outcomes equivalent to those seen before treatment de-escalation, Talcott begins. This approach holds significance for elderly patients, who make up a substantial proportion of those diagnosed with breast cancer, Talcott says.

In many cases, older patients have contending comorbidities, and recommending an aggressive treatment regimen aimed at combatting their malignancy could lead to unwarranted toxicities, Talcott expands. In such instances, it becomes evident that another medical condition may be a more apparent driver on their overall health. Additionally, older patients may encounter challenges related to transportation to medical appointments or access to a robust support system capable of assisting them in managing adverse effects, Talcott emphasizes. There is an overall interest within the medical community to de-escalate treatment for these patientswhenever appropriate.

A notable area of interest revolves around the use of radiation therapy, which traditionally constitutes a standard component of early-stage breast cancer management, especially following breast-conserving surgery, Talcott explains. Alternative treatment strategies have emerged to deliver the benefits of radiation therapy to older patients, he says. These strategies focus on achieving local disease control with a reduced number of treatment sessions and utilizing more targeted approaches to minimize treatment-related adverse effects, Talcott adds.

Overall, it is important to recognize that the elderly patient population is heterogeneous, and age alone does not necessarily reflect a patient’s physiological status, he continues. Consequently, tailoring treatment recommendations should extend beyond considering age as a sole criterion and should emphasize crafting personalized treatment plans for each patient's unique needs, preferences, and goals in cancer care, he emphasizes. This approach ensures that elderly patients receive the most suitable and meaningful treatment regimens that alignwith their specific circumstances, Talcott concludes.