Think Twice About Breast Cancer Surgery in Frail Seniors

A study published in JAMA Surgery found frail female nursing community residents who undergo breast cancer surgery exhibit high rates of mortality and hospital readmission, in addition to loss of functional independence, reports MedScape . The researchers identified 5,969 female residents from Medicare claims data between 2003 and 2013 who had undergone inpatient breast cancer surgery. They used the Minimum Data Set Activities of Daily Living (MDS-ADL) summary score to analyze preoperative and postoperative function and identified subject characteristics associated with 30-day and 12-month mortality and 12-month functional decline after surgery. The women were 82 years old on average and mostly white, and 57 percent were cognitively impaired. Sixty-one percent underwent axillary lymph node dissection (ALND) with lumpectomy or mastectomy, 28 percent received a mastectomy, and 11 percent had a lumpectomy. Thirty-day mortality was 18 percent in the lumpectomy group, 4 percent in the mastectomy group, and 2 percent in the ALND group. Twelve months after surgery, mortality was highest in the lumpectomy group at 41 percent, followed by 30 percent after mastectomy and 29 percent after ALND. Surgery survivors had a rate of functional decline ranging from 56 percent to 60 percent. The functional MDS-ADL dependency score rose by three points for lumpectomy, four points for mastectomy, and five points for ALND.