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Breast cancer surgery in frail elderly ‘linked to poor results’

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Breast cancer surgery is associated with high rates of mortality and hospital readmission, along with loss of functional independence, for frail nursing home residents, according to US researchers.

As a result, they recommended that hormonal therapy or symptom management should be considered for older nursing home residents.

“The risks of harm may outweigh the benefit in this frail, vulnerable population”

Emily Finlayson

The researchers found that 58% of women who resided in a nursing home for more than 90 days before breast cancer surgery experienced significant functional decline one year after surgery.

The study found that women with functional impairment in their daily activities prior to treatment had the highest rates of one-year mortality and functional decline.

Patients with prior cognitive impairment also had higher rates of functional decline after one year, said the study authors in the journal JAMA Surgery.

The findings were based on analysis on over a decade of data on 5,969 women aged 67 and older who had lived in a nursing home for at least 90 days and had undergone inpatient breast cancer surgery.

Of these, 61% received the most invasive treatment – axillary lymph node dissection with lumpectomy or mastectomy – 28% received a mastectomy and 11% underwent the least invasive lumpectomy.

Researchers examined 30-day and one-year mortality, hospital readmission rates, and functional status in activities of daily living, such as eating, dressing and using the bathroom.

Lead author Dr Victoria Tang, from the University of California, San Francisco, said: “Surgery often cures the cancer, but can have a negative impact on elderly patients’ everyday activities and worsen their quality of life.

“This study shows that for frail, elderly patients, breast cancer care should be individualised and goal-oriented, with the option of only providing hormonal therapy or symptom management, instead of surgery,” she said.

The researchers recommended that long-term nursing home residents with breast cancer consider hormonal therapy, such as endocrine therapy or radiotherapy, or symptom management only instead of surgery.

Senior author Professor Emily Finlayson added: “While some clinicians, patients and caregivers believe breast surgery is necessary to prevent morbidity and mortality from breast cancer, the risks of harm may outweigh the benefit in this frail, vulnerable population, in which many have a limited life expectancy.”

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