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 Breast Cancer Surgery in Elderly Women Linked to Hospital Readmission, Study Says

A new study reports that breast cancer surgery among frail, elderly women residing in nursing care centers is associated with loss of functional independence and high rates of hospital readmission and mortality.

Researchers at the University of California, San Francisco (UCSF), used 2003-2013 claims information from all U.S. Medicare nursing care centers to review data for 5,969 women ages 67 and older who had lived in a nursing center for at least 90 days and who underwent inpatient breast cancer surgery. The study examined 30-day and one-year mortality, hospital readmission rates, and functional status in activities of daily living, including eating, dressing, and using the bathroom.

About 58 percent of women residing in a nursing center for over 90 days before breast cancer surgery experienced significant functional decline one year after surgery. In addition, elderly women with functional impairment in their daily activities prior to treatment had the highest rates of one-year mortality and functional decline. Individuals with prior cognitive impairment also had higher rates of functional decline after one year.

“These findings establish benchmark data for this population and provide cautionary information for practitioners considering offering breast cancer surgery with the hope of prolonging life or improving functioning in frail older women with cognitive and significant functional impairment,” the study said.

Of the population studied, 61 percent (3,661) of the patients received the most invasive treatment, axillary lymph node dissection with lumpectomy or mastectomy (ALND). About 28 percent (1,642) received a mastectomy, and 11 percent (666) underwent the least invasive lumpectomy.

The study found that the rates were high for 30-day readmission (16 percent overall, 15 percent ALND, 14 percent mastectomy, 26 percent lumpectomy). The rates were also high for all-cause mortality at 30 days (3.2 percent overall, 2 percent ALND, 4 percent mastectomy, 8.4 percent lumpectomy) and one year (31 percent overall, 29 percent ALND, 30 percent mastectomy, 41 percent lumpectomy).

Breast cancer surgery is the most common cancer operation performed in nursing center residents, comprising 61 percent of such procedures, according to the study. In addition, over half of female nursing center residents are identified with suspected breast cancer through screening or physical exam, and about two-thirds of those are referred for diagnosis or treatment.

“Surgery often is associated with curing cancer, but can worsen other, more life-limiting comorbidities and function of nursing home residents,” the study said. “In addition, clinical practice guidelines in oncology demonstrate consensus that breast cancer treatment decisions for older women, including surgery, should be individualized based on treatment benefits and harms as well as patient preferences.”

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