Chemo for elderly women

I have a friend who is 86 years old and recently had a mastectomy on her left side.  Her tumor was ER-neg., 2.5 cm, aggressive, with 3 lymph nodes positive.  She has a history of heart problems ( recent angioplasty and is on coumadin), and tends to be anemic. She has also been on Estrogen for 50 years due to a hysterectomy at 35.  She is still on Estrogen.  Her doctor wants to do chemotherapy - CMF protocol - 6 rounds every 3 weeks.  I think she might be too fragile for this and wonder about the necessity of having her go through this treatment when the doctor says it will give her a 15-20% chance of not having a reoccurence.  I know everyone is different, but at her age, and given her health, is this an appropriate protocol for her??

Nano

[CCF-RN,MSN-JS]

Dear Nano, Chemotherapy CMF has been recommended to your friend as adjuvant therapy.  Adjuvant treatment is given after surgery to try to prevent or minimize the growth of microscopic deposits of tumor cells that might grow into a recurrent tumor.  In a Stage IIB situation (tumor larger than 2 cm and positive lymph nodes) the possibility that the tumor has spread is greater.   Because her tumor was estrogen receptor negative this is why they are recommending chemotherapy rather than tamoxifen.  The CMF combination was most likely chosen as the methotrexate has less cardiac toxicity associated with it than other drugs that are commonly used in combination adjuvant therapy.   Treatment lasts four to six months in most adjuvant programs.

Whether to proceed with chemotherapy in consideration of her age, health status, and quality of life would need to be up to her.  This, of course, after discussion of all of the risks (potential side effects of the treatment taking into account her other health problems), and benefits (prevention or minimization of the growth of possible microscopic deposits of tumor cells that may grow into a recurrent tumor).  Each person differs in terms of the importance they might place on the risks and benefits of treatment.