Breaking News
January 15, 2019 - AHA: New Cholesterol Guidelines Put Ethnicity in the Spotlight
January 15, 2019 - Different brain areas linked to smoking and drinking
January 15, 2019 - Henry Marsh shares insights into neurosurgery and more at Dean’s Lecture Series
January 15, 2019 - Want to Live Longer? For Just 30 Minutes a Day, Do Anything Else But Sit
January 15, 2019 - The Current issue of “The view from here” is concerned with Targets
January 15, 2019 - Plain packaging sparked tobacco price rises, new study finds
January 15, 2019 - Sedentary lifestyles can be unhealthy, physical activity can lower risk
January 15, 2019 - Gut microbiome may help prevent development of cow’s milk allergy
January 15, 2019 - Lesbian, gay and bisexual individuals more likely to suffer severe substance use disorders
January 15, 2019 - New England Journal of Medicine Publishes Positive Results of the Pivotal Trial of Cablivi (caplacizumab) for Rare Blood Clotting Disorder
January 15, 2019 - Levels of inflammatory marker (CRP) linked to housing type and tenure
January 15, 2019 - Three gifts I’m glad I gave myself in 2018
January 15, 2019 - Columbia’s Pediatrics Department Names New Vice Chairs, Expands Leadership
January 15, 2019 - US FDA Accepts Regulatory Submissions for Review of Tafamidis to Treat Transthyretin Amyloid Cardiomyopathy
January 15, 2019 - Staying fit can cut your risk of heart attack by half
January 15, 2019 - Vitamin D supplements are of no gain to those over 70, study shows
January 15, 2019 - Scientists create comprehensive new method to predict breast cancer risk
January 15, 2019 - Research shows connection between social media use and impaired risky decision-making
January 15, 2019 - FDA Approves Expanded Use of Adacel (Tdap) Vaccine for Repeat Vaccination
January 15, 2019 - Treating spinal pain with replacement discs made of ‘engineered living tissue’ moves closer to reality
January 15, 2019 - Providers Walk ‘Fine Line’ Between Informing And Scaring Immigrant Patients
January 15, 2019 - Outcomes Poorer for Medicaid Beneficiaries With STEMI
January 15, 2019 - Decorative Products on Foods Can Be Unsafe
January 15, 2019 - A dream of sustainable surgery in Uganda
January 15, 2019 - Study shows how herpes viruses and tumors have learned to manipulate the same ancient RNA
January 15, 2019 - Common Heart, Diabetes Meds May Help Ease Mental Illness
January 15, 2019 - Stress and trauma in earliest years linked to reduced hippocampal volume in adolescence
January 15, 2019 - Scientists identify endogenous activator of sigma-1 receptors in human cells
January 15, 2019 - MAR treatments unlikely to be cause of premature or low birth weight babies
January 15, 2019 - Parental CPTSD increases transmission of trauma to offspring of Tutsi genocide survivors
January 15, 2019 - High-fat diets shown to increase blood pressure
January 15, 2019 - New institute for food safety to be established in Netherlands
January 15, 2019 - Keele University researchers receive £2.4 million grant to help reduce overprescribing of opioids
January 15, 2019 - Synthetic compound reverses mutant p53 aggregate accumulation, study shows
January 15, 2019 - First elder care robot tested in a WSU smart home apartment
January 15, 2019 - Oxford researchers explore relationship between technology use and adolescent mental health
January 15, 2019 - From microbiome research to healthier and sustainable foods
January 15, 2019 - How coaching moms and dads improves infants’ language skills
January 15, 2019 - Precision health approach tapped to identify causes of poverty
January 14, 2019 - DNA origami can accurately measure how antibodies interact with several antigens
January 14, 2019 - Researchers identify multiple new subtypes of most common childhood cancer
January 14, 2019 - Total Fertility Rates Vary by State
January 14, 2019 - Elevated blood lead level in early childhood associated with increased risk of academic problems in school-aged children
January 14, 2019 - Superior technique identified that can block CRISPR gene editing
January 14, 2019 - Turning breast cancer cells into fat cells prevents the formation of metastases
January 14, 2019 - Review examines what influences HIV-positive patients to stay on antiretroviral drugs in Africa
January 14, 2019 - Identifying genetic factors that lead to squamous cell carcinoma
January 14, 2019 - Virtual video visits can replace office visits without compromising quality of care
January 14, 2019 - Health Highlights: Jan. 10, 2019
January 14, 2019 - Scientists uncover how protein clumps damage cells in Parkinson’s
January 14, 2019 - Physician-scientist’s “indomitable spirit” prevails over personal adversity
January 14, 2019 - King’s researchers receive £1.25 million to investigate fatal eating disorder
January 14, 2019 - UCR researchers uncover how plants sense temperature
January 14, 2019 - Scientists find link between colitis and colon cancer
January 14, 2019 - New skin patch provides long-acting contraceptive protection
January 14, 2019 - Asparagine synthetase deficiency – Genetics Home Reference
January 14, 2019 - Improved stem cell approach could aid fight against Parkinson’s
January 14, 2019 - New class of sleeping pill preserves ability to wake in response to danger signals
January 14, 2019 - Cancer patients are four times more likely to commit suicide
January 14, 2019 - The human brain works in reverse order to retrieve memories
January 14, 2019 - Simple tips can lead to better food choices
January 14, 2019 - Meth’s Resurgence Spotlights Lack Of Meds To Combat The Addiction
January 14, 2019 - TARA Biosystems and Insilico Medicine collaborate to discover novel therapies for cardiac disease
January 14, 2019 - Early life stress in mice affects their offspring behavior
January 14, 2019 - Depression Tied to Worse Asthma Outcomes in Urban Teens
January 14, 2019 - Santa calorie counting
January 14, 2019 - Opiod prescriptions for pet dogs misused by their masters
January 14, 2019 - People with ASD could be better at recognizing regret and relief in others finds study
January 14, 2019 - Conducting ChIP-Seq with Low Cell Numbers
January 14, 2019 - Study explores support and social networks of family carers of people with dementia
January 14, 2019 - At Risk for an Opioid OD? There’s an App for That
January 14, 2019 - Single national electronic health record will help improve care in Canadian hospitals
January 14, 2019 - Study unearths Britain’s first speech therapists
January 14, 2019 - Study reveals nuances of racial inequalities in breast cancer prevention
January 14, 2019 - Air pollution can raise the risk of miscarriage among women finds study
January 14, 2019 - An extra meal a day cuts deaths by half in elderly with hip fractures
January 14, 2019 - Researchers report vision-based neurotransmitter events for the first time
January 14, 2019 - Pharmacists could significantly reduce ED crowdedness
January 14, 2019 - PTSD linked with cardiovascular disease and cancer, study shows
January 14, 2019 - New analytic model can accurately predict patients at risk of developing PTSD
Breast cancer surgery in frail elderly women linked to poor results

Breast cancer surgery in frail elderly women linked to poor results

image_pdfDownload PDFimage_print
Credit: CC0 Public Domain

An analysis of more than a decade of U.S. nursing home data has shown that breast cancer surgery is associated with high rates of mortality and hospital readmission, along with loss of functional independence, for frail nursing home residents.

In a study appearing Aug. 29, 2018, in JAMA Surgery, UCSF researchers found that 58 percent 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.

“Surgery often cures the cancer, but can have a negative impact on elderly patients’ everyday activities and worsen their quality of life,” said lead author Victoria Tang, MD, MAS, assistant professor of geriatrics and of hospital medicine at UCSF and the affiliated San Francisco VA Health Care System. “This study shows that for frail, elderly patients, breast cancer care should be individualized and goal-oriented, with the option of only providing hormonal therapy or symptom management, instead of surgery.”

Breast cancer surgery is the most common cancer operation performed in nursing home residents, constituting 61 percent of procedures. More than half of female nursing home residents are identified with suspected breast cancer through screening or physical exam, and about two-thirds of those are referred for diagnosis or treatment.

In the JAMA Surgery study, Tang and her colleagues used 2003-2013 claims from all U.S. Medicare nursing homes to review data for 5,969 women ages 67 and older who had lived in a nursing home for at least 90 days and who underwent inpatient breast cancer surgery. In this group (83 percent white, 57 percent cognitively impaired), 61 percent (3,661) of the patients received the most invasive treatment, known as axillary lymph node dissection with lumpectomy or mastectomy (ALND). Another 28 percent (1,642) received a mastectomy, and 11 percent (666) 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.

The researchers noted that the rates were high for 30-day readmission (16 percent overall, 15 percent ALND, 14 percent mastectomy, 26 percent lumpectomy) and 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).

“The highest mortality rate was associated with the least invasive procedure, lumpectomy, which appeared to be performed in the sickest patients,” Tang said. “A higher mortality rate is somewhat expected due to advanced age and increased co-morbidities present in nursing home residents. However, a 30-day mortality of 8 percent is much higher than would be anticipated for a surgical procedure that is generally considered very low risk.”

The researchers recommend 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. Further studies should specifically evaluate this population in the outpatient setting and compare outcomes in those with and without the surgical intervention. Tools to support informed decision-making also are needed, they said.

The deferring of breast cancer surgery in frail elderly women is similar to prostate specific antigen (PSA) testing, Tang said. PSA testing is common in elderly men despite evidence that those without aggressive prostate cancer are unlikely to benefit from diagnosis and treatment and may face significant risks for quality of life if they undergo prostate surgery.

“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,” said senior author Emily Finlayson, MD, MS, professor of surgery, health policy and geriatrics at UCSF.


Explore further:
Lumpectomy + radiation may cut breast cancer mortality in DCIS

Journal reference:
JAMA Surgery

Provided by:
University of California, San Francisco

Tagged with:

About author

Related Articles