DOI: 10.1080/03007995.2019.1615422

Breast cancer remains one of the leading causes of cancer-related deaths among women globally. In their ground-breaking study published in October 2019 in *Current Medical Research and Opinion*, Goyal et al. offer a comprehensive analysis of treatment patterns, survival rates, and the economic impact on Medicare-enrolled, older patients with hormone receptor-positive, human epidermal growth factor receptor 2-negative (HR+/HER2-) metastatic breast cancer (MBC).

The United States faces a significant public health challenge with an aging population and an increasing incidence of breast cancer diagnoses in older women. This demographic shift amplifies the need for a health care system adequately prepared to address the complex medical and economic considerations of these patients’ treatment pathways.

In their retrospective study, Goyal and colleagues analyzed the data of patients diagnosed with HR+/HER2- MBC. They investigated several aspects of patient care, from the various treatment protocols employed to the survival rates and associated health care costs of these treatments.


HR+/HER2- MBC is a subtype of breast cancer characterized by the presence of hormone receptors and absence of excess HER2 protein. This cancer type often spreads beyond the breast and is particularly challenging to treat in older patients due to their typically poorer prognosis and the increased likelihood of comorbidities. The study by Goyal and his team sheds light on real-world clinical practices, outcomes, and financial strains affecting this vulnerable patient population.


Using data from the Medicare database, the researchers identified women aged 65 and older who were newly diagnosed with MBC between January 2011 and December 2015. Treatments were categorized into chemotherapy, hormone therapy, targeted therapy, and combinations thereof, with details on the sequence of treatments recorded. Economic analyses focused on Medicare reimbursements and out-of-pocket expenses for these patients.


The study found notable diversity in treatment patterns, reflecting the complexities of managing HR+/HER2- MBC in older adults. Hormone therapy emerged as the most common first-line treatment, followed by chemotherapy. Targeted therapies were less frequent. This distribution aligns with clinical recommendations prioritizing less aggressive treatments that can maintain patients’ quality of life.

Median survival time across all patients was approximately 26 months, highlighting the aggressive nature of HR+/HER2- MBC. The study also illuminated substantial economic burdens, with significant variations in costs linked to different treatment regimens. Patients and Medicare bore high expenses, particularly with combined treatment approaches.


Goyal et al.’s study emphasizes the heterogeneity in treating HR+/HER2- MBC in older women and the pressing need for cost-effective and personalized approaches that consider patients’ quality of life. It also calls for further research into optimizing treatment sequences to balance efficacy, tolerability, and cost.

Implications and Future Directions

The findings from the work of Goyal and his colleagues have profound implications. Practitioners must weigh the benefits of treatment against potential risks and the financial strain on the healthcare system and individual patients. As treatment paradigms evolve, newer, targeted therapies may become more prevalent, offering better outcomes at potentially higher costs.

The study also underscores the importance of personalized medicine. By tailoring treatment to individual patient needs, outcomes may improve without added financial burdens. Policymakers and healthcare providers must address these issues to improve survival rates and quality of life for older women with HR+/HER2- MBC.


1. Goyal, R. K., Cuyun Carter, G., Nagar, S., Smyth, E. N., Price, G. L., Huang, Y.-J., Li, L., Davis, K. L., & Kaye, J. A. (2019). Treatment patterns, survival and economic outcomes in Medicare-enrolled, older patients with HR+/HER2- metastatic breast cancer. Current Medical Research and Opinion, 35(10), 1699-1710. [DOI: 10.1080/03007995.2019.1615422]

2. American Cancer Society. (2021). Breast Cancer Facts & Figures 2021-2022. American Cancer Society, Inc.

3. National Comprehensive Cancer Network. (2021). NCCN Clinical Practice Guidelines in Oncology: Breast Cancer. Version 6.2021.

4. Mariotto, A. B., Enewold, L., Zhao, J., Zeruto, C. A., & Yabroff, K. R. (2020). Medical Care Costs Associated with Cancer Survivorship in the United States. Cancer Epidemiol Biomarkers Prev, 29(7), 1304-1312.

5. Siegel, R. L., Miller, K. D., Fuchs, H. E., & Jemal, A. (2021). Cancer Statistics, 2021. CA: A Cancer Journal for Clinicians, 71(1), 7-33.


1. Metastatic Breast Cancer Treatment
2. HR+/HER2- Breast Cancer
3. Senior Cancer Patient Care
4. Medicare Cancer Costs
5. Breast Cancer Survival Rates

The results of Goyal et al.’s study deeply enhance the current understanding of HR+/HER2- MBC treatment in older women. As the population ages and incidences of such cancer cases rise, the insights provided will be instrumental in shaping future research, clinical practices, and health policies to improve the lives of those affected by this disease.