Many Older Women With Early Stage Breast Cancer Are Susceptible to Functional Decline After Starting Treatment

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In older women with stage I-III breast cancer, approximately 20% lost the ability to complete some of the basic tasks of independent living within 1 year of starting treatment. In addition, responses to a survey can assist in identifying those women at risk of experiencing this posttreatment functional decline.1

Functional status can serve as a key measurement of overall health, with previous research showing an association between functional decline and an greater probability of dying, a decreased likelihood of recovery from serious illness, and diminished tolerance for cancer treatment. Functional decline can also increase financial burden and stress.

Researchers examined 184 women who were at least 65 years old and had a recent diagnosis of stage I-III breast cancer. To identify patients most at risk for functional decline, potentially enabling preventive interventions, researchers administered the Vulnerable Elders Survey.

The Vulnerable Elders Survey is a 13-item, self-administered tool that predicts functional decline or death within 12 months, validated in community-living elderly people. Study participants completed the survey before treatment for breast cancer was initiated.

The probability of functional decline or death rose with increasing survey scores. Within 12 months, 34 of the 184 patients experienced function decline, and 7 died. Women who lacked education beyond high school were disproportionately affected.

“Our findings are important because the study validates the Vulnerable Elders Survey as a useful tool for identifying older women with breast cancer who may be at increased risk for functional decline within a year of treatment initiation. This instrument offers the opportunity for early identification and will inform the development of interventions to prevent and address functional decline for those particularly at risk, such as women with low socioeconomic status,” said Cynthia Owusu, MD, MS, of Case Western Reserve University, Cleveland, Ohio, and first author of the study.

“Such efforts may in the long term translate to improved treatment tolerance and better breast cancer outcomes.”


1. Owusu C, Margevicius S, Schluchter M, et al. The Vulnerable Elders Survey and socioeconomic status predict functional decline and death among older women with newly diagnosed non-metastatic breast cancer. Cancer. 2016 Jun 27. doi:10.1002/cncr.30046. [Epub ahead of print]

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