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Dose intensity and hematologic toxicity in older breast cancer patients receiving systemic chemotherapy

  1. Michelle Shayne MD1,
  2. Eva Culakova PhD, MS2,
  3. Debra Wolff MS, PCNP2,
  4. Marek S. Poniewierski MD, MS2,
  5. David C. Dale MD3,
  6. Jeffrey Crawford MD2,
  7. Gary H. Lyman MD, MPH2,†,*

Article first published online: 11 AUG 2009

DOI: 10.1002/cncr.24560

Issue

Cancer

Cancer

Volume 115, Issue 22, pages 5319–5328, 15 November 2009

Additional Information

How to Cite

Shayne, M., Culakova, E., Wolff, D., Poniewierski, M. S., Dale, D. C., Crawford, J. and Lyman, G. H. (2009), Dose intensity and hematologic toxicity in older breast cancer patients receiving systemic chemotherapy. Cancer, 115: 5319–5328. doi: 10.1002/cncr.24560

Author Information

  1. 1

    Department of Medicine, University of Rochester and the James P Wilmot Cancer Center, Rochester, New York

  2. 2

    Department of Medicine, Duke University and the Duke Comprehensive Cancer Center, Durham, North Carolina

  3. 3

    Department of Medicine, University of Washington, Seattle, Washington

  1. †

    Fax: (919) 681-7488

*Duke University, 2424 Erwin Road, Suite 205, Durham, NC 27705

Publication History

  1. Issue published online: 3 NOV 2009
  2. Article first published online: 11 AUG 2009
  3. Manuscript Accepted: 27 APR 2009
  4. Manuscript Revised: 23 MAR 2009
  5. Manuscript Received: 5 NOV 2008

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Keywords:

  • breast cancer;
  • aging;
  • colony-stimulating factor;
  • dose intensity;
  • neutropenic complications

Abstract

BACKGROUND:

This prospective study evaluated patient and treatment characteristics that contributed to hematologic toxicity in older breast cancer patients treated with curative intent in the community setting.

METHODS:

Data were collected on 1224 patients with stage I through III breast cancer, of whom 207 were aged ≥65 years (grading determined according to the American Joint Committee on Cancer staging system). Primary outcome measures included anemia, thrombocytopenia, severe neutropenia, febrile neutropenia, and both planned and actual relative dose intensity (RDI). Comparisons between older and younger patients regarding hematologic toxicity and reductions in RDI were based on univariate and multivariate logistic regression analyses.

RESULTS:

The neutropenic complication rate in older patients (45.1%) was not significantly different from that in the younger patients (43.7%). There were also no significant differences in rates of anemia or thrombocytopenia. Approximately 34.0% of the older patients received RDI <85% compared with 20.0% among younger patients (P < .01). Fewer older patients received anthracycline-based chemotherapy (64.3% compared with 83.8% in younger patients, P < .01). Fewer older patients received prophylactic white blood cell colony-stimulating factor (18.4%) compared with younger patients (28.0%) (P < .01).

Conclusions:

There were no significant differences noted with regard to chemotherapy-related hematologic toxicities between older and younger breast cancer patients in this large prospective observational study. This may be explained, in part, by more frequent reductions in RDI and less frequent utilization of anthracyclines among older patients. Cancer 2009. © 2009 American Cancer Society.

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