No Benefits Found in Breast Surgery for Nursing Home Patients

A new study finds that female nursing home residents who undergo breast cancer surgery experience significant functional decline and increased mortality.

Researchers at the University of California, San Francisco (UCSF; USA) and San Francisco Veterans Affairs Medical Center (VA; CA, USA) conducted a study involving 5,969 female US nursing home residents (mean age, 82 years; 83.1% white) who underwent inpatient breast cancer surgery, based on Medicare claims issued from 2003 to 2013. The researchers examined both preoperative and postoperative function and identified patient characteristics associated with 30-day and one year mortality, and functional decline one year after surgery.

Overall, 11.2% of the patients underwent lumpectomy, 27.5% underwent mastectomy, and 61.3% underwent lumpectomy or mastectomy with axillary lymph node dissection (ALND). The results revealed that 30-day mortality rates were 8% after lumpectomy, 4% after mastectomy, and 2% after ALND. One-year mortality rates were 41% after lumpectomy, 30% after mastectomy, and 29% after ALND. Among one-year survivors, the functional decline rate was 56-60%. After adjustment, preoperative decline in activities of daily living (ADL) score and cognitive impairment were significantly associated with one-year functional decline across all breast cancer surgery groups. The study was published on August 29, 2018, in JAMA Surgery.

“When someone gets breast cancer in a nursing home, it’s very unlikely to kill them. They are more likely to die from their underlying condition,” said study co-author Laura Esserman, MD, director of the UCSF breast cancer center. “Among patients who survived at least one year, 58% suffered a serious downturn in their ability to perform ADL, such as dressing, bathing, eating, using the bathroom, or walking across the room.”

Surgery late in life is more common than many realize. One-third of Medicare patients undergo surgery the year before they die, 18% have surgery in their final month of life, and 8% during their final week, according to a 2011 study published in The Lancet. In addition, nearly one in five women with severe cognitive impairment get regular mammograms, although the results suggest that residents of nursing homes generally will not to live long enough to benefit from breast screening.

Related Links:
University of California, San Francisco
San Francisco Veterans Affairs Medical Center