Breast cancer is a major health problem for older women in the U.K. Older women have a high incidence of breast cancer and present with breast cancer that is often advanced, yet they may be treated less comprehensively. There appears to be limited evidence to support the prescription of chemotherapy for women over 70 years of age since this group of women are often excluded from participating in clinical trials.

A systematic review of the literature was undertaken to identify, appraise and synthesize knowledge relevant to the central question: What is known about the impact of chemotherapy on older women with breast cancer?

The systematic and rigorous approach to the review was guided by procedures set out by the Centre for Reviews and Dissemination, University of York (2001). Electronic databases (MEDLINE, CINAHL, Cochrane, Web of Science, AgeInfo) and grey literature from clinical areas were included in a comprehensive search which initially identified 604 relevant research articles and documents.

Following assessment of quality and relevance, 128 articles were retrained for in-depth review. Emergent themes included: treatment regimes; physical symptoms; psychological, social and spiritual functioning; roles and responsibilities; and patient empowerment and participation in decision making. Evidence indicated that the ability of older women to tolerate standard treatments is conflicting; there is uncertainty about the actual effectiveness of adjuvant chemotherapy; true involvement in decision making is fundamental; and ageist, paternalistic attitudes can be detrimental to well-being.

This review will provide a credible knowledge base for future research and scholarly activity and be useful to nurses and other health care professionals around the world. These findings are intended to contribute towards the goal of ensuring that women of advanced age are offered and have access to optimal cancer treatments.