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With the ongoing ageing of western societies, the proportion of older breast cancer patients will increase. For several years, clinicians and researchers in geriatric oncology have urged for new clinical trials that address patient-related endpoints such as functional decline after treatment of older patients. The aim of this study was to present an overview of trial characteristics and endpoints of all currently running clinical trials in breast cancer, particularly in older patients. The clinical trial register of the United States National Institutes of Health Differences was searched for all current clinical trials on breast cancer treatment. Trial characteristics and endpoints were retrieved from the register and differences in characteristics between studies in older patients specifically (defined as a lower age-limit of 60 years or older) and trials in all patients were assessed using χ(2) tests. We included 463 clinical trials. Nine trials (2 %) specifically investigated breast cancer treatment in older patients. Ninety-one breast cancer trials included any patient-related endpoint (20 %), while five trials specifically addressing older patients included any patient-related endpoint (56 %, P = 0.02). Five of the trials in older patients incorporated a geriatric assessment (56 %). Clinical trials still rarely incorporate patient-related endpoints, even in trials that specifically address older patients. Trials that are specifically designed for older patients do not often incorporate a geriatric assessment in their design. This implicates that current clinical studies are not expected to fill the gap in knowledge concerning treatment of older breast cancer patients in the next decade.

Over 40% of breast cancer patients are diagnosed above the age of 65. Treatment of these elderly patients will probably vary over countries. The aim of this study was to make an international comparison (several European countries and the US) of surgical and radiation treatment for elderly women with early stage breast cancer. Survival comparisons were also made. Data were obtained from national or regional population-based registries in the Netherlands, Switzerland, Ireland, Belgium, Germany, and Portugal. For the US patients were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Early stage breast cancer patients aged ≥ 65 diagnosed between 1995 and 2005 were included. An international comparison was made for breast and axillary surgery, radiotherapy after breast conserving surgery (BCS), and relative or cause-specific survival. Overall, 204.885 patients were included. The proportion of patients not receiving any surgery increased with age in many countries; however, differences between countries were large. In most countries more than half of all elderly patients received breast conserving surgery (BCS), with the highest percentage in Switzerland. The proportion of elderly patients that received radiotherapy after BCS decreased with age in all countries. Moreover, in all countries the proportion of patients who do not receive axillary surgery increased with age. No large differences in survival between countries were recorded. International comparisons of surgical treatment for elderly women with early stage breast cancer are scarce. This study showed large international differences in treatment of elderly early stage breast cancer patients, with the most striking result the large proportion of elderly who did not undergo surgery at all. Despite large treatment differences, survival does not seem to be affected in a major way.

In order to obtain insight in attitudes towards detection and management of hepatic metastases of colorectal origin, a questionnaire was sent to hospitals in 13 Western countries. Response rate was 98.0% (n = 284). In almost all hospitals (98%) some method of follow-up was employed. Carcino-embryonic antigen (CEA) determinations were performed in 84% of all hospitals: most frequently in Germany and the U.S.A., but only in 50% of the British hospitals. Hepatic resection for liver metastases was performed in 95% of all hospitals. Resectability criteria varied considerably among the countries. In the majority of German and American hospitals multiple hepatic metastases were considered resectable (including bilobar disease in 58% of German hospitals). In the majority of British and Dutch hospitals only solitary metastases were considered resectable, or liver resections were not performed at all. The mean reported number of liver resections annually per hospital, reflecting these attitudes, was 11.2 and 7.2 for German and American hospitals, and 2.1 and 1.8 for British and Dutch hospitals respectively. When irresectable hepatic metastases were diagnosed, some form of chemotherapy was applied in 74% of hospitals. Hepatic artery infusion of chemotherapeutics was performed most frequently. The mean reported number of medically treated patients annually per hospital was 34 for Germany, 18 for the U.S.A., and 12 and 9 for Great Britain and the Netherlands respectively. Adjuvant chemotherapy was performed after liver resection in 30% of all hospitals, most frequently in German and American hospitals. Considerable disparity was observed in attitudes towards detection and in management of hepatic metastases among Western countries. On the basis of the reported 1421 liver resections and 3590 medically treated patients (annually) it is concluded that selection of the best detection and treatment policies is obviously hampered by insufficient clinical data and inconclusive evidence of purported optimal approach. To determine the optimal policy useful information can only be provided by inclusion of patients in prospective randomized trials.