A study released yesterday in JAMA Surgery strongly suggests that the risks outweigh the benefits of breast cancer surgery for the majority of older women who reside in nursing homes.
“Surgery often cures the cancer, but can have a negative impact on elderly patients’ everyday activities and worsen their quality of life,” said Victoria Tang, assistant professor of geriatrics and of hospital medicine at the University of California, San Francisco. Surgery of this type, the study authors noted in their conclusion, can even hasten death for such patients. In fact, up to 41 percent of the patients studied died after one year; that's significantly more than the 25 percent of nursing home residents who would typically die over a single year.
“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,” Tang noted. The researchers also recommended considering endocrine therapy or radiotherapy.
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To arrive at that conclusion, researchers analyzed data from 10 years of Medicare claims filed on behalf of nearly 6,000 women age 67 and older who lived in nursing homes. The women had undergone breast surgeries such as lumpectomy or mastectomy; many also had underlying conditions such as cognitive decline, diabetes or heart failure.
Following lumpectomy surgery, in particular, researchers found the highest rates of hospital readmission (26 percent) as well as the highest rates of death after both 30 days (8 percent) and one year (41 percent). They also saw significant functional impairment in carrying out daily activities such as eating, dressing and using the bathroom, and noted that cognitive impairment was significantly associated with this decline.
Tang explained that the striking results following lumpectomy likely stemmed from its being the procedure most likely to be performed in the sickest patients. Still, she noted, while a higher mortality rate would be somewhat expected with older nursing home patients who may have other health issues, “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.”