Ms. Smith was 87 years old when she came to see me. Approximately four years prior to that, she was diagnosed with breast cancer.

Fortunately, her cancer was hormone sensitive. She elected to remove her breast and was later on started on a hormone pill. She was doing well and following up with another oncologist.

She then developed pain in her back and red spots on an area of her breast. She saw her oncologist. He did appropriate tests and informed her that her breast cancer had recurred and spread to her bones and chest wall.

It became stage 4. She was 87 at that time and the oncologist recommended hospice and told her she may have three months to live.

She was 87, but active and feeling OK and elected to come and see me. I had a long discussion with the patient, her daughter-in-law and several other family members. She did not want chemotherapy and that makes sense.

It is very common to offer hospice to elderly patients rather than hope, but I believe in looking at physiologic age rather than chronological age. Some elderly patients, like her, are doing very well. Trying sensible treatment is reasonable.

Untreated cancer also hurts quality of life. Decisions should be based on comparing possible side effects with therapy and worsening quality of life with uncontrolled cancer. Many times, it is not how long you live, but how well you live.

We started her on another hormone therapy combination. She was started on Ibrance and Faslodex. Ibrance is a pill you take at home once a day for three weeks with a one-week break and Faslodex is an injection you get once a month in my office. This was two years ago and she is still doing very well and she is very active, walks a mile and a half and lives independently.

As I reported in my last article, I attended the largest cancer conference in the world. There were almost 32,000 cancer specialists from more than 125 countries. There was excellent research presented about a drug similar to Ibrance called Kisqali. It showed that patients lived longer with this drug in metastatic breast cancer.

My patient is doing very well. She has not required chemotherapy. She has an excellent quality of life. We need to remember that there are lots of advances being made in cancer treatment.

Dr. Sunil Gandhi is a hematologist and oncologist. He is volunteer medical adviser of the Citrus Unit of American Cancer Society. Write to 521 N. Lecanto Highway, Lecanto, FL 34461, email sgandhi@tampabay.rr.com or call 352-746-0707.

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