When Looking at Older Women, Researchers See Links Between Frailty, Race and Failing to Start Hormonal Therapy

Breast Cancer News
August 22, 2014
Erin Rowley, Writer and Content Coordinator
Reviewed By: 
M. Tish Knobf, PhD, RN, FAAN, AOCN

A study reported in the Journal of Clinical Oncology found most older women with hormone receptor-positive breast cancer follow their doctors’ orders to begin hormonal therapy. But those numbers are not as high when looking at non-white women and those deemed “frail.”

Background and Goals

Women ages 65 and up make up almost half of all people with breast cancer in the United States. Of those women, about 70 percent have estrogen receptor-positive, ER-positive, breast cancer. This type of cancer may stop growing or die when treated with substances that block estrogen.

Women with ER-positive disease are often given hormonal therapies such as tamoxifen and aromatase inhibitors. At the time of this study, guidelines recommended they stay on these medicines for at least 5 years following initial treatment.

Past studies found that older women are less likely to begin hormonal therapy, and more likely to stop taking it once they start, than younger women. But those studies did not consider how frailty played a role.

The researchers define frailty as problems with daily mental, emotional and physical tasks. Frailty is related to age, but is observed at different levels in people within the same age group.


Participants, aged 65 to 91, were chosen from a group of 1,288 women with invasive, early-stage breast cancer. A total of 1,062 of them had ER-positive cancer. Each person was interviewed when she joined the trial, 6 months after joining, and then once a year for up to 7 years.

Based on how they responded to a 35-item survey that asked about physical and emotional health (such as hearing, eyesight, energy level and existence of additional conditions, such as diabetes or stroke) and lifestyle (such as ability to clean and cook for one’s self and take care of one’s own appearance), researchers gave the women one of three labels.


  • 76.4 percent were “robust,” or in the healthiest group
  • 4.9 percent were “frail,” or in the least healthy group
  • 18.7 percent were “pre-frail,” in between the two


About 14 percent of participants never began their hormonal therapy. Women deemed “frail” or “pre-frail” were 1.63 times as likely not to start treatment at all, and non-white women were 1.71 times more likely than their white peers not to start treatment.

Among those who did start treatment, there was a 48.5 percent chance they would continue their therapy for at least 5 years. Unlike other research, this study found no evidence that type of hormonal treatment, attitude about treatment, or interactions between women and their doctors influenced refusal to start treatment.

The researchers concluded that since women who were pre-frail or frail were less likely to start hormonal therapy than their robust peers, the frail and pre-frail women and their doctors probably looked at life expectancy and the risk of recurrence, as well as the effect hormonal therapy would have on quality of life.

What This Means for You

The researchers are concerned by the number of women who stopped their therapy before the 5-year mark. They say future studies should take place to consider the role that treatment-specific symptoms and interactions with other illnesses play in causing people to stop taking their medicine early.

New guidelines recommend women take hormonal therapy for 10 years instead of 5, so the fact that so many women stop their therapy after a short period of time is especially relevant now.

This study suggests that if you’re an older woman with breast cancer, it may be useful for you to talk to your doctors about your risk of recurrence versus risk for side effects.

This study also has implications for non-white women with breast cancer. For more information, check out LBBC resources such as  Getting Connected: African-Americans Living Beyond Breast Cancer and visit lbbc.org for more information tailored to your specific needs.

Sheppard, VB, Faul, LA, Luta, G et al.  Frailty and Adherence to Adjuvant Hormonal Therapy in Older Women With Breast Cancer: CALGB Protocol 369901. Journal of Clinical Oncology. Published online ahead of print, July 2014.

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Additional Related Topics 
Hormone Receptor-Positive