Functional decline, death common in older women within year of starting breast cancer treatment

One in five older women with newly diagnosed nonmetastatic breast cancer died or experienced functional decline within 12 months of treatment initiation, according to the results of a longitudinal study.

Further, patients with a high school diploma or less were more likely to experience functional decline, and a self-administered survey predicted functional decline and death in this cohort.

“Within a year of initiating treatment for breast cancer, approximately one in five older women with stage I to stage III breast cancer lost the ability to independently complete some of the basic tasks of daily life necessary for living independently within the community and at home, higher than has been found in studies from noncancer patients,” Cynthia Owusu, MD, MS, assistant professor of medicine at Case Western Reserve University, said in a statement provided to HemOnc Today.

The Vulnerable Elders Survey (VES-13) — a 13-item self-administered functional assessment — has demonstrated that community-dwelling elders with scores of 3 were four times more likely to experience functional decline or death at 2 years.

However, the VES-13 has never before been studied in a cancer population. It had been unclear whether VES-13 results could predict functional decline among patients with cancer undergoing treatment and during the early survivorship period, during which the opportunity exists to intervene.

Owusu and colleagues examined the utility of VES-13 in predicting functional decline among 184 patients aged 65 years or older (mean age, 74.9 years; range, 65-93) who were newly diagnosed with nonmetastatic breast cancer. Thirty-three percent of the cohort was black — researchers enrolled one black patient for every two white patients two examine racial disparities — and 44% had a high school education or less.

Death or functional decline — defined as at least a one-point decrease in score on the Activities of Daily Living or Instrumental Activities of Daily Living scales — served as the study’s primary outcome measures.

Participants completed the VES-13 at baseline, before adjuvant or neoadjuvant chemotherapy.

The median duration from diagnosis to baseline assessment was 2.1 months (interquartile range [IQR], 1.2-3). Median follow-up was 12.1 months (IQR, 11.6-12.7).

The mean baseline vulnerable elders survey score was 2.3.

Twenty-two percent (n = 41; 50% white) of patients experienced functional decline (n = 34) or death (n = 7).

The risk for functional decline/death increased from 23% with a VES-13 score of 3 to 76% for a VES-13 score of 10.

Results of a univariate analysis showed baseline VES-13 score, age, race, education, marital status, median household income, Charlson comorbidity index, stage and surgery were associated with functional decline or death (P < .01 for all).

“It is unfortunate but not surprising that once again older African Americans and women of lower socioeconomic status are disproportionately affected by functional disability and decline, a key summary measure of health,” the researchers wrote. “This speaks to the general poor health of these two patient populations and may partly explain the poorer breast cancer outcomes experienced by African Americans and women of lower socioeconomic status. It is, therefore, imperative for efforts to be developed and focused on improving the functional health of at-risk populations; otherwise, racial and socioeconomic-related disparities will only widen.”

In a multivariate analysis, independent predictors for functional decline or death included higher VES-13 scores (OR for each 1-point increase = 1.37; 95% CI, 1.18-1.57) and having a high school education or less (OR = 2.47; 95% CI, 1.08-5.56).

Researchers acknowledged that because the cohort came from a single institution, these findings may not be generalizable. Further, researchers did not account for treatment duration or recurrences. – by Nick Andrews

For more information:

Cynthia Owusu, MD, MS, can be reached at cynthia.owusu.case.edu.

Disclos ure: Owusu reports no relevant financial disclosures. One researcher reports ownership interest in American Renal Associates.