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Weighing the risks and benefits of breast cancer treatment in elderly women

A recent study looked at survival rates and the ability of frail elderly women to function following surgical breast cancer treatment.

Doctors and breast cancer patients together have many factors to consider when determining the best course of breast cancer treatment. For the most part, a decision is made for the most effective treatment. However, even when successful, the treatment itself can bring disadvantages to the quality of life. In an elderly person with limited life expectancy and perhaps already other diseases occurring, health professionals have asked whether treatment is actually the best choice.

Until a recent publication in JAMA Surgery little information was available to help make the best decision for elderly women in nursing homes. A research group from the USA looked specifically at 5696 women older than 67 years, in nursing homes. To be included in the study the women had to have had surgery and stayed overnight in the hospital, as part of their breast cancer treatment.

The researchers asked the question of whether the ability of women to complete daily tasks independently, such as dressing, eating, going to the toilet, was affected by the surgery. They made a comparison of women’s abilities to do this before the surgery and up to one year after the surgery. The researchers also looked at the survival rates and complications that may have occurred as part of the surgery for up to one year after the breast cancer treatment.

Surgery can affect the ability of even middle-aged women to complete daily tasks due to the pain and limited ability to move the arm properly caused. In this study of elderly women, whose average age was 82 years, the greatest decline in this ability occurred in the women who had the most invasive surgery. This was mastectomy and lymph node removal.

Women who just had a lump removed actually had the lowest survival at one year following the surgery, but the researchers believe that this is most likely because they had a simple surgery because they were already too unwell to undergo a more invasive surgery.

Many of the women already had illnesses such as diabetes or heart failure, prior to breast cancer treatment. Almost 60% of the women had cognitive impairment, which means difficulty with remembering, concentrating and making decisions.

The greatest decline in ability to complete daily tasks and the lowest survival rates were seen in women who had cognitive impairment and already had a poor ability to function independently before the breast cancer treatment. Overall 31% of women died within a year of their breast cancer treatment, and 58% experienced a significant decline in their ability to function independently.

The researchers believe that their results may provide evidence that non-surgical treatment may be preferable in elderly women who are already sick and frail. They discuss that death from other causes may occur before the breast cancer causes symptoms and pain. They recommend further research be done on the complications that can occur from breast cancer treatment in frail elderly patients to help with decision-making.

Written by Nicola Cribb, VetMB DVSc Dip.ACVS

Reference: Tang V, Zhao S, Boscardin J, et al. Functional Status and Survival After Breast Cancer Surgery in Nursing Home Residents. Jama Surg. 2018. doi:10.1001/jamasurg.2018.2736.

Nicola Cribb
Nicola Cribb
Nicola obtained her Veterinary and Master’s degrees from the University of Cambridge, UK, and Doctor of Veterinary Science from the University of Guelph, Canada. She is board-certified in surgery and has research interests in minimally-invasive surgery. She has worked in a clinical setting, as well as research and teaching disciplines for the past 16 years at the University of Guelph, where she is currently Adjunct Faculty. She is a freelance medical writer and reviews, authors, and co-authors publications and reviews in scientific journals and books.
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