Specialized breast cancer care for older patients

For providers, breast cancer treatment for older adults involves a unique set of clinical considerations that differ significantly from those of younger patients. These considerations include the establishment of a unique risk/benefit profile for each patient to balance treatment outcomes with comorbidities, medication needs, functional status, and quality-of-life priorities. Penn Medicine’s Older Adult Oncology Program provides specialized, multidisciplinary care focused on these unique objectives and needs.

Approximately 80% of Penn Medicine’s breast cancer patients are over the age of 65. Recognizing a need for dedicated care services for this population, the Older Adult Oncology program at Penn Medicine is now available at several locations. Launched at Penn Medicine Princeton Health in 2023, the program has since expanded to Lancaster General Hospital and Pennsylvania Hospital, with planned expansion to Penn Presbyterian Medical Center and the Hospital of the University of Pennsylvania in the future.

“We’ve been nationally and internationally recognized for the quality of care for older adults,” says Ramy Sedhom, MD, who notes that Penn Medicine Princeton Health received the 2025 Association of Cancer Care Centers Innovator Award for its geriatric oncology program. Dr. Sedhom is the section chief of medical oncology at Penn Medicine Princeton Health and co-director of the Center for Cancer & Aging at the Penn Center for Cancer Care Innovation.

Delivering holistic, individualized care for breast cancer patients

The management of breast cancer in older adults requires a different clinical approach than in younger patients. Many older patients face unique clinical and social challenges that influence treatment decisions. “There are complexities to treating all patients, but it’s very different to navigate cancer as an 85- or a 90-year-old compared to a 40- or 50-year-old,” says Dr. Sedhom. “That’s because you’re also balancing many other domains that might be impacted, such as other diseases that are present.”

In addition to comorbidities, older breast cancer patients may have physical limitations that affect treatment, cognitive issues that impede communication, and limited social support that complicates care.

Penn Medicine’s Older Adult Oncology Program addresses these challenges through individualized, multidisciplinary care that prioritizes both clinical outcomes and the well-being of patients. “We’re trying to do both: maximizing cures, but also maximizing quality of life for patients,” says Dr. Sedhom.

Finding the right breast cancer treatment

“The geriatric oncology program is very unique and hugely beneficial for patients because a lot of data exists now in the breast cancer space where we’re able to de-escalate care for older patients,” says Ashley Newman, MD, a breast surgeon at Penn Medicine Princeton Health. By offering modified or abridged therapies, physicians ensure that patients still receive effective treatments, but with fewer harmful side effects.

Through the Older Adult Oncology Program, patients undergo a thorough assessment of their health status, goals, and individual preferences, a process that unites the goals of medical oncologists and surgeons.

“Geriatric oncologists will assess patients for frailty, which helps me with surgical planning and understanding appropriateness for surgery,” says Dr. Newman. “And, from a medication management perspective, they make sure that there’s no polypharmacy on board post-operatively or during treatment.” Pharmacists are consulted to review each patient’s medications and flag concerns ahead of treatment.

In addition, the multidisciplinary assessment helps physicians determine if radiation therapy is necessary or will do more harm than good. Often, patients with low-risk breast cancer may forgo radiation treatment or receive an accelerated course. These considerations can spare older patients from severe side effects and the need for frequent travel.

Improving quality of life for older-adult cancer patients

A key component of the program is connecting patients to supportive services tailored to their individual needs. A dedicated geriatric oncology nurse navigator facilitates access to resources such as nutritional counseling, social work, palliative care, and geriatric specialty care.

Geriatric oncology social workers support older cancer patients in ways that improve the care experience and ensure continuity of treatment. Social workers provide coping strategies to manage stress and anxiety, help facilitate advance care planning, and connect patients with resources for transportation, food, and financial assistance.

In addition, Penn Medicine’s palliative care services are integrated into this program, with a focus on maximizing quality of life, enhancing the care experience, and supporting communication for patients and their families. “We often say that palliative care is most effective when it is interdisciplinary. So, for our older patients with incurable breast cancer, we offer a pathway for integrated whole-person care,” says Dr. Sedhom.

In addition to specialized nurse navigators and social workers, the care team may include physical and occupational therapists, as well as home health aides to assist with mobility issues and frailty. Patients are also provided with referrals to free legal assistance for help with matters such as personal planning, benefits and pensions, and housing.

Clinical research dedicated to geriatric breast cancer

The exclusion of older patients with breast cancer from clinical trials has resulted in a lack of evidence-based guidance for the care of this population. To fill this gap, Penn Medicine’s researchers create clinical trials specifically for older adults.

“One study that’s about to start, the BEACON study, is looking at the best ways to communicate with older patients with breast cancer to help them make decisions regarding surgery,” says Dr. Sedhom. “We’re looking at how to best communicate with a patient about potential outcomes, thinking of the best and/or worst-case scenario, and what their wishes are.”

Penn Medicine is also participating in nationwide trials for patients with breast cancer over 65, such as the CDK4/6 Inhibitor Dosing Knowledge (CDK) Study. This study, led by the American Society of Clinical Oncology, is evaluating an alternative dosing strategy for CDK4/6 inhibitors (palbociclib or ribociclib). The purpose of the study is to help older patients with metastatic breast cancer tolerate side effects and stay on treatment longer.

Peace of mind for patients, families, and providers

When a complex older patient is referred to Penn Medicine, the geriatric oncology team takes ownership of every aspect of care, from managing comorbidities and medications to addressing functional and psychosocial needs alongside cancer treatment.

“We do our best to be personalized for patients and families,” says Dr. Sedhom. “We’re also very thoughtful about how we can help the provider. We know that every physician is too busy, and we do our best to not just take care of the patient’s cancer needs, but everything else that’s impacted by cancer. So, we’re really here to serve patients, families, and referring providers.”

Referrals and consultations

Providers can refer a patient to Penn Medicine by calling 877-937-7366 or by placing a referral order online.