ArticleJournal of the National Cancer Institute2026
Early discontinuation of chemotherapy in older adults with early breast cancer: results from the prospective multicenter HOPE study.
Article in Journal of the National Cancer Institute, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeOlder adults with early-stage breast cancer (EBC) receiving neo/adjuvant chemotherapy frequently discontinue treatment early. However, the incidence, risk factors, and survival implications of early discontinuation remain poorly understood.
methodsThis is a post-hoc analysis of 501 older adults (aged≥65) with EBC treated with neo/adjuvant chemotherapy from the Hurria Older PatiEnts (HOPE) Study. Prior to chemotherapy, we collected sociodemographic, clinical, and geriatric assessment characteristics. The primary outcome was early discontinuation (yes/no), defined as not completing all planned chemotherapy. We used multivariable logistic regression with stepwise selection to identify pretreatment risk factors and the Kaplan-Meier method to evaluate the impact of discontinuation on survival.
resultsOf 501 participants (median [range] age, 70 [65-86] years), 113 (23%) had early discontinuation. After multivariable analysis, ≥1 fall within 6 months (odds ratio [OR] = 2.06, 95% CI: 1.11-3.81, p = 0.02) and an activity of daily living score <85 (OR = 2.00, 95% CI: 1.26-3.18, p = 0.003) were identified as risk factors for early discontinuation. Participants with both risk factors were at highest risk (OR = 4.61, 95% CI: 2.18-9.79, p < 0.001). With a median follow up of 4.3 years, early discontinuation was not associated with worse overall or breast cancer-specific survival but was associated with higher non-breast cancer-specific mortality (Hazard Ratio = 2.94, 95% CI 1.22-7.07, p = 0.02).
conclusionIn this cohort of older adults with EBC, nearly one-quarter discontinued chemotherapy early. Early discontinuation was associated with increased non-cancer related mortality but not cancer-related mortality, emphasizing the importance of identifying high-risk older adults and optimizing treatment delivery.
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