Which older patients with hormone receptor positive, HER2 negative breast cancer should receive chemotherapy?

Discussions with older patients are similar in many ways to the discussions with our younger patients. What is the risk of recurrence (taking into account anatamy and biology), what therapies might impact that risk of recurrence, what are the patient's comorbities, and what are the patients preference. I use Oncotype routinely to determine the benefit of chemotherapy. BUT - it isn't appropriate if you aren't going to act on the results. If the patient won't acccept chemo no matter what the risk and potential benefit, don't do the test. If the patient's comorbidities preclude safely administering chemo, don't do it.