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Purpose: A few previous studies report a direct relationship between older age and chemotherapy‐induced neuropathy. This study further evaluated this adverse event's age‐based risk. Methods: CALGB 40101 investigated adjuvant paclitaxel (80 mg/m2 once per week or 175 mg/m2 every 2 weeks) in patients with breast cancer and served as a platform for the current study that investigated age‐based differences in neuropathy. Grade 2 or worse neuropathy, as per Common Terminology Criteria for Adverse Events version 4, was the primary endpoint; patients were assessed at baseline, every 6 months for 2 years, and then annually for 15 years. Results: Among these 1,881 patients, 230 were 65 years of age or older, 556 were 55–64 years, and 1,095 were younger than 55; 1,226 neuropathy events (commonly grade 1 or 2) were reported in 65% of the cohort. The number of grade 2 or worse events was 63 (27%), 155 (28%), and 266 (24%) within respective age groups (p =.14). In univariate analysis, only motor neuropathy had a higher age‐based incidence: 19 (8%), 43 (8%), and 60 (5%), respectively (p =.04); in multivariate analyses, this association was no longer statistically significant. Other endpoints, such as time to onset of neuropathy (time from trial enrollment to neuropathy development) and time to improvement (time from maximal grade sensory neuropathy to a one‐category improvement), showed no statistically significant age‐based differences. In contrast, obesity was associated with neuropathy, and every 2‐week paclitaxel was associated with trends toward neuropathy. Conclusion: Although paclitaxel‐induced neuropathy is common, older age is not an independent risk factor. Clinical trial identification number. NCT00041119 (CALGB 40101). Implications for Practice: Age alone is not an independent risk factor for paclitaxel‐induced neuropathy. Mixed results have been reported regarding whether older cancer patients are at a greater risk for chemotherapy‐induced neuropathy. This article further evaluates the age‐based risk of this adverse event. [ABSTRACT FROM AUTHOR]

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Purpose Delays to adjuvant chemotherapy initiation in breast cancer may adversely affect clinical outcomes and patient satisfaction. We previously identified an association between genomic testing (Oncotype DX) and delayed chemotherapy initiation. We sought to reduce the interval between surgery and adjuvant chemotherapy initiation by developing standardized criteria and workflows for Oncotype DX testing. Methods Criteria for surgeon-initiated reflex Oncotype DX testing, workflows for communication between surgeons and medical oncologists and a streamlined process for receiving and processing Oncotype DX requests in pathology were established by multidisciplinary consensus. Criteria for surgeon-initiated testing included patients ⩽ 65 years old with T1cN0 (grade 2 or 3), T2N0 (grade 1 or 2), or T1/T2N1 (grade 1 or 2) breast cancer on final surgical pathology. Medical oncologists could elect to initiate Oncotype testing for cases falling outside the criteria.Wethen examined 720 consecutive patients with breast cancer who underwent Oncotype DX testing postoperatively between January 1, 2014 and November 28, 2016 and measured intervals between date of surgery, Oncotype DX order date, result received date and chemotherapy initiation date (if applicable) before and after intervention implementation. Results The introduction of standardized criteria and workflows reduced time between surgery and OncotypeDXordering and time from surgery to receipt of result, by 7.3 days (P,.001) and 6.3 days (P<.001), respectively. The mean number of days between surgery and initiation of chemotherapy was also reduced by 6.4 days (P = .004). Conclusion Developing consensus on Oncotype DX testing criteria and implementing streamlined workflows has led to clinically significant reductions in wait times to chemotherapy decision making and initiation. [ABSTRACT FROM AUTHOR]