Surgery related to breast cancer is considered a low-risk intervention. But when performed on elderly patients, it can significantly impact life expectancy while increasing functional dependence, according to a study published online Aug. 29 in JAMA Surgery.
“For female nursing home residents who underwent breast cancer surgery, 30-day mortality and survival, as well as one-year mortality and functional decline, were high,” wrote lead author Victoria Tang, MD, MAS, with the division of geriatrics at the University of California, San Francisco, and colleagues. “The one-year survivors had significant functional decline. This study’s findings suggest that this information should be incorporated into collaborative surgical decision-making processes.”
Breast cancer surgery is the most common cancer-related surgical procedure for nursing home residents. But outcomes, according to the authors, in such populations are not clearly understood. For this study, the research team examined Medicare data from 2003 to 2013 to identify a cohort of 5,969 nursing home residents in the U.S. The women had an average age of 82 years and 83.1 percent were white.
Most women—61.3 percent—underwent lumpectomy or mastectomy with axillary lymph node dissection (ALND), while 11.2 percent underwent lumpectomy and 27.5 underwent mastectomy.
Mortality at 30 days was 8 percent for lumpectomy, 4 percent for mastectomy and 2 percent for ALND. At one year, the rates were 41 percent for lumpectomy, 30 percent for mastectomy and 29 percent for ALND. Regardless of procedure, for those who survived one year, 55 to 60 percent experienced functional decline.
“A higher mortality rate is somewhat expected because of advanced age and increased comorbidities in nursing home residents,” Tang et al. wrote. “However, a 30-day mortality of 8.4 percent is higher than would be anticipated for a surgical procedure that is generally considered to be low risk.”
The authors believe this baseline data can improve decision making for practitioners when examining costs and benefits of breast cancer surgery in older, frail women. Considering the relatively high mortality rate at one year, multimodality therapy should be considered as an alternative to surgery.
Nicholas joined TriMed in 2016 as the managing editor of the Chicago office. After receiving his master’s from Roosevelt University, he worked in various writing/editing roles for magazines ranging in topic from billiards to metallurgy. Currently on Chicago’s north side, Nicholas keeps busy by running, reading and talking to his two cats.