Surgery is the modality often used to treat breast cancer in female nursing home residents, but postoperative mortality and functional decline for some patients is high.1Although surgical intervention for breast cancer may be viewed as low-risk, age and the burdens of surgery can be greater for older female nursing home residents who may already have comorbidities and a limited life expectancy. Death from other causes may occur before the woman experiences symptoms and pain from breast cancer.
Victoria Tang, MD, MAS, of University of California, San Francisco, and colleagues noted that older and/or functionally impaired women are typically not included in clinical trials; therefore, treatment recommendations for this patient group are unclear.1Therefore, they sought to determine the long-term functionality and mortality outcomes for older female nursing home residents with breast cancer to better inform decision making regarding surgical intervention for these patients. Their study findings suggest that preoperative function and cognitive impairment may be significant decision-making considerations.1
What the Numbers Show
In this retrospective study of Medicare claims from 2003-2013, Dr Tang and colleagues included 5969 female patients (mean age 82 years ± 7 (SD)) with breast cancer who were nursing home residents. A total of 83.1% of the patients were treated with surgery by one of three approaches: mastectomy alone (27.5%), lumpectomy alone (11.2%), and mastectomy or lumpectomy plus axillary lymph node dissection (ALND; 61.3%). More than half of the patients showed some cognitive and/or functional impairment prior to surgery.1
Patients were tracked for 30-day and 1-year mortality rates along with functionality changes at 1 year after surgical intervention according to Minimum Data Set Activities of Daily Living (MDS-ADL) scoring. Postoperative MDS-ADL scores were compared with preoperative scores.1
Short-term mortality was higher for the lumpectomy group than for the others; the postoperative mortality rates at 30 days were approximately 4% with mastectomy alone, 8.5% with lumpectomy alone, and approximately 2% with ALND. At 1 year, these rates were 30%, 41%, and 29%, respectively.1