Adjuvant therapeutic decisions in elderly breast cancer patients: the role of chemotherapy in a retrospective analysis.

PURPOSE: Decisions on the type of adjuvant treatment in older breast cancer patients are challenging. Side effects of chemotherapy have to be weighed against life expectancy, comorbidities, functional status, and frailty on the basis of studies usually excluding patients over 69 years. To aid this decision, we analyzed a database of 6000 unselected patients and of those evaluated elderly primary breast cancer patients with hormone receptor-negative tumors from 1963 until 2003 in respect of survival data depending on adjuvant treatment. METHODS: A total of 131 elderly (i.e., >65 years) patients were observed retrospectively for a median of 72 months. Patients received breast-conserving therapy or mastectomy and adjuvant radiotherapy, chemotherapy, and endocrine therapy. Data were collected from a hospital-intern database. RESULTS: Median age at diagnosis was 72 years. Mostly, tumors were small (81 % T1, 17 % T2) but of unfavorable grading (40 % G2, 35 % G3). Lymph nodes were positive in 42 %. Mastectomy was performed in 65 %. While 42 % of patients received radiotherapy, only 10 % were treated with chemotherapy. Patients with G2 and G3 tumors (p = 0.027), younger women (p = 0.012), and patients with positive lymph node status (p < 0.0001) more likely received chemotherapy. Recurrence-free survival was longer in patients without chemotherapy (37 vs. 29 months, p = 0.234). Overall survival was non-significantly shorter in patients who received chemotherapy (59 vs. 81 months, p = 0.131). CONCLUSIONS: In this analysis, adjuvant chemotherapy was not associated with improved survival, presumably caused by an a priori poor prognosis of these patients. For an aging society more data are urgently needed to help selecting and personalizing adjuvant treatment within subgroups of breast cancer in older women.

[Persistent left atrial thrombus in atrial fibrillation under oral anticoagulation]. / Persistierender linksatrialer Thrombus bei Vorhofflimmern unter oraler Antikoagulation.

The case of a 78-year-old female patient who suffered atrial fibrillation and persistent thrombus in the left atrial appendage despite sufficient anticoagulation is reported. The case is chosen to demonstrate the complexity inherent in prophylaxis as well as risk evaluation of thromboembolism on the basis of clinical and echocardiographic criteria. We also discuss transesophageal echocardiography as the standard diagnostic procedure for detection of intracardiac thrombi prior to cardioversion as well as cardiac computer tomography as an alternative.

Ageing of the cardiovascular system during 33 years of aerobic exercise.

BACKGROUND: increasing age affects aerobic capacity, with an average loss of 10% or more per decade. AIM: to determine the effect of ageing on the circulatory system in middle-aged men during 33 years of physical training. METHODS: 15 men initially aged 45 years took part in an exercise training programme for 25-33 years. Nine serial measurements were made at rest and during maximal effort. Aerobic training consisted of swimming, jogging, walking and cycling 3-4 times per week. Sessions were for 61-70 min at 77-84% of heart rate reserve. RESULTS: there was no change in resting heart rate, blood pressure, percentage fat or body composition. Minimal cardiovascular losses at maximal work included 5.8-6.8% in maximal oxygen uptake per decade, 25 beats in maximum heart rate and 26 beats in heart rate reserve. CONCLUSION: exercise training has a favourable effect on ageing of the cardiovascular system in older men, resulting in minimal loss of oxygen uptake, no rise in resting blood pressure and no change in body composition.

Cardiovascular changes with age and exercise. A 28-year longitudinal study.

Various studies report a 0-22% per decade decline in circulatory function (VO2max) with advancing age. Twelve exercising men (E) were followed for 28 years, mean age 43 and 71 years, initial to final measurement, while 12 dropouts (C) detrained for 21 years, with a mean age from first to last measurement of 48 and 69 years, respectively. VO2 max in E changed from 45.9 to 39.4 ml.min-1.kg-1, 5% per decade, whereas C declined from 36.0 to 21.4 ml.min-1.kg-1, 19% per decade. Resting blood pressure was unchanged in E, 119/75 mmHg, whereas C rose from 128/85 to 149/90 mmHg. The data suggest that regular aerobic exercise forestalls the usual loss of circulatory function with increasing age.

Effect of exercise on cardiovascular ageing.

Ageing of the cardiovascular system presents several costly public health problems, loss of quality of life, dependency, and other various health hazards. Large declines of 0-24% per decade in cardiovascular function have been cited in the literature but no long-term longitudinal studies have been reported. Serially measured cardiovascular function was performed on 12 normal men, aged 44-79 years, at 0, 10, 15, 20 and 25 years. Over the same time period, daily exercise training data were reported monthly including mode, frequency, intensity, and duration. Although seven men developed some form of pathological disease, the total group's cardiovascular function remained 60% greater than the average of ten investigations. The overall decline in cardiovascular function (Vo2 max) was 13%, or 5% per decade, 45.4 ml.min-1.kg-1 to 39.5 ml.min-1.kg-1. In summary, cardiovascular function was one-half, or 0.24 ml.min-1.kg-1.year-1 of the 0.45 ml.min-1.kg-1.year-1 reported to be the average decline for ageing cited in the literature.

Effects of ageing and physical training on the peripheral sweat production of the human eccrine sweat gland.

Epidemiological studies suggest that thermoregulatory function declines with ageing. Therefore, it was the purpose of this study to examine the effects of physical training and ageing on the peripheral sweat rate of the human sweat gland. Maximum oxygen uptake and peripheral sweat rate (pilocarpine iontophoresis) were determined in 40 male volunteers (10 sedentary younger men, 10 endurance-trained younger men, 10 sedentary older men, and 10 endurance-trained older men). Maximum oxygen uptake and peripheral sweat rate were significantly (p less than 0.05) greater in the two endurance-trained groups compared to their sedentary counterparts. Furthermore, when matched for maximum oxygen uptake, younger and older men had similar mean peripheral sweat rate values. These results suggest that participation in lifelong aerobic exercise may retard the decrease in peripheral sweat production usually associated with ageing. Further work is needed, however, to determine if such changes can improve overall thermoregulatory function in elderly people.

Effect of training on VO2max, thigh strength, and muscle morphology in septuagenarian women.

The purpose of this study was to determine the effects of a long-term (50 wk) combined aerobic-resistance training program on maximal oxygen consumption (VO2max, thigh strength, and vastus lateralis fiber morphology in healthy septuagenarian women (mean age = 72 +/- 6 yr). Subjects volunteered to be in either an exercise (Ex; N = 17) or control (Con; N = 10) group. Con subjects were 34% less active in winter than in summer, Ex subjects maintained their summer activity level on exercise days in winter. Initial, intermediate (20 wk), and final (50 wk) measurements were made for isokinetic knee extension/flexion strength; VO2max and morphological measurements from a muscle biopsy were made at the initial and final times only. Both groups gained in leg strength (Ex = +6.5%; Con = +7.8%; P less than or equal to 0.05) during the summer; in the winter the Ex group maintained leg strength and the Con group declined 12.2% (P less than or equal to 0.05). The fast-twitch muscle fiber area (Type IIb) increased 29% (P less than or equal to 0.001) in the Ex group and declined 26% (P = 0.014) in the Con group. VO2max increased only in the Ex group (16%; P less than 0.001). We conclude that healthy septuagenarian women can increase aerobic capacity, leg strength, and Type IIb muscle fiber area with a long-duration, combined aerobic-resistance exercise program.

The Effect of Physical Activity and Inactivity on Aerobic Power in Older Men (A Longitudinal Study).

In brief To assess the decline in maximal aerobic power (V O2max) with age, two groups of men were studied: Fifteen exercisers were followed from age 45 to 68, and 15 controls were measured while training at age 52 and again at age 70 after being detrained for 18 years. Resting blood pressure of 120/78 was unchanged in the exercisers but rose from 135/85 to 150/90 in the nonexercisers. V O2max measured by open circuitry declined 13% in the exercisers from 44.4 to 38.6 ml-min(-1)-kg(-1); in the nonexercisers it declined 41% from 34.2 to 20.3 ml-min(-1)· kg(-1). The V Omax loss was primarily due to a combined loss of maximal heart rate and stroke volume. The data suggest that regular aerobic exercise retards the usual loss in aerobic power with age and present important implications for the aging population in relation to social, economic, and health benefits.

A Longitudinal Study of Cardiovascular Stability in Active Men Aged 45 to 65 Years.

In brief: Cross-sectional studies of physical performance generally show a linear decline in maximum aerobic power (V O2 max) with increasing age (about 1% to 2% per year). In the study described in this article, 15 men were serially followed for 20 years. They performed exercises consisting of walking, running, swimming, and cycling for an average of 3.6 days per week and requiring an energy expenditure of 2,104 kcal per week. Over the 20 years, directly measured V O2 max declined 12% (from 44.4 to 38.9 ml· kg(-1)· min(-1), or 0.27 ml· kg(-1)· min(-1) per year). Essentially no differences were seen in resting heart rate or arterial blood pressure. The authors conclude that physical training forestalls the decline in V O2 max until at least age 65.

VO2max during horizontal and inclined treadmill running.

The VO2max response of 12 well-trained and highly motivated college males was measured using two treadmill protocols: horizontal (H) and inclined (I). The duration of each test averaged 10 min. In the H test the treadmill bed was horizontal with the running rate held constant for the first 6 min, after which time it was increased at 1-min intervals to near maximal subject running speed, according to the HR response, until exhaustion. The I method simulated the protocol of Costill and Fox, with the treadmill speed at about 80-90% of mean maximal running rate established from 12- and 15-min track runs. The treadmill bed was held horizontal during the first 4 min, after which time it was elevated to 4% and elevated 2% each 2 min thereafter until exhaustion. No significant differences were found in VO2max, 4.267 1/min (I), and 4.192 1/min (H), average max HR, 190.4/MIN (I), and 188.9/min (H); respiratory rate, 56.4/min (I), and 62.0/min (H); and VEBTPS, 145.2 1/min (I), and 143.3 1/min (H). It was concluded that the intensities of both treadmill methods, H and I, were sufficient to produce a nonsignificant difference in maximal VO2 values with the type subjects employed.

Physiological variables during 10 years of endurance exercise.

The reported decline in Physical Working Capacity (PWC) max is from 9-15 percent during the ages of 45 to 55 years. The use of vigorous physical activity to prevent this decline and to possibly protect against fatal myocardial infarction has been suggested. The purpose of this study was to investigate the effect of an endurance type exercise program on the maximal PWC of middle-aged men during a 10 year span. Sixteen men, initially 32-56 years (M-44.6), were trained with running or swimming at an intensity above 60 percent of VO2 max during a 10 year period. The average weekly running distance was 15 miles (25 km). The criterion for PWC was directly measured VO2 using the Douglas Bag/Scholander technique. No changes were observed in body weight, resting heart rate (HR), or resting blood pressure (BP). Maximal HR declined 7 beats per minute in 10 years. Pulmonary ventilation (STPD) increased approximately 18 percent. Mean VO2 max was essentially unchanged, 3.376 and 3.303 1/min STPD. VO2 max related to body weight was 43.7 initially and 44.4 ml/min-kg after 10 years. It was concluded that the usual 9-15 percent decline in PWC or VO2 max from age 45 to 55 years can be forestalled by regular endurance exercise. The results may have implications for protecting against heart attacks.