Health
Altered Frailty Status in Elderly Patients Receiving Locoregional Therapy for Early Breast Cancer
In a cohort study reported in the study letter of JAMA surgery, Minami et al. found that frailty worsened in a significant proportion of elderly patients undergoing locoregional therapy (including lumpectomy or mastectomy) for early-stage breast cancer. Baseline robustness and mastectomy were associated with an increased risk of worsening frailty.
Survey details
This study included women aged 65 years and older with ductal carcinoma in situ (DCIS) or stage I hormone receptor-positive and HER2-positive breast cancer, who were assessed by surveillance, epidemiology, end result (SEER) and linked Included in the Medicare database and received locoregional therapy. January 2010 and October 2015. Frailty status was assessed by a claims-based frailty index over the period from diagnosis to 1 year post-diagnosis.
Main findings
The analysis included 31,084 women (median age = 73 years). Of these, 22.6% underwent mastectomy and 77.4% underwent lumpectomy.
At diagnosis, 55.6% of patients were robust (54.6% in the mastectomy group and 55.9% in the lumpectomy group), 40.3% were pre-frail (40.7% and 40.2%), and 3.8% were mildly frail (4.2% and 3.6%) , and 0.3%. % had moderate/severe frailty (0.4% and 0.2%).
Worsening frailty occurred in 21.4% of patients, including 24.8% in the mastectomy group and 20.4% in the mastectomy group.
In adjusted analyses, factors significantly associated with worsening frailty status were:
- Mastectomy versus mastectomy (odds ratio) [OR] = 1.31, 95% CI = 1.23–1.39)
- Baseline robust vs moderate/severe frailty (OR = 6.12, 95% CI = 2.80–13.35)
- Age 75–79 (OR = 1.21, 95% CI = 1.12–1.31), 80–84 (OR = 1.53, 95% CI = 1.40–1.66), and ≥85 (OR = 1.94, 95% CI = 1.75) –2.13) vs 65-69 year olds
- Blacks vs Caucasians (OR = 1.12, 95% CI = 1.01–1.24).
The investigator said: “4.1% of women over the age of 65 have her DCIS [or] Stage I breast cancer was frail at diagnosis, but 21.4% experienced a clinically significant decline. Those who were robust at diagnosis and those who underwent mastectomy had significantly higher probabilities of decline. Adjusting the intensity of locoregional treatment in this population is important. Because data from clinical trials show similar survival between lumpectomy and mastectomy, radiotherapy and axillary surgery can be safely omitted in early-stage older people. [hormone receptor–]positive disease. That women in the robust category are more likely to develop frailty after locoregional therapy suggests that thoughtful treatment decisions should be made in all older women, not just those who were frail at diagnosis. It suggests that
Christina A. Minami, MD, MS,of Breast Cancer Program, Dana-Farber/Brigham and Women’s Cancer Centeris the corresponding author JAMA Surgery article.
Disclosure: This study was funded by the Beale Fellowship of Brigham and Women’s Hospital Surgery. For full disclosure of the study authors, please see: jamanetwork.com.
The content of this post has not been reviewed by the American Society of Clinical Oncology (ASCO®) and does not necessarily reflect the views or opinions of ASCO®.
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