Note: Lead authoer Victoria Tang, MD, is a current KL2 Scholar.
UCSF researchers recommend hormonal therapy or symptom management in older nursing home residents
An analysis of more than a decade of U.S. nursing home data has shown that breast cancer surgery is associated with high rates of mortality and hospital readmission, along with loss of functional independence, for frail nursing home residents.
In a study appearing Aug. 29, 2018, in JAMA Surgery, UCSF researchers found that 58 percent of women who resided in a nursing home for more than 90 days before breast cancer surgery experienced significant functional decline one year after surgery. The study found that women with functional impairment in their daily activities prior to treatment had the highest rates of one-year mortality and functional decline. Patients with prior cognitive impairment also had higher rates of functional decline after one year.
"Surgery often cures the cancer, but can have a negative impact on elderly patients' everyday activities and worsen their quality of life," said lead author Victoria Tang, MD, MAS, assistant professor of geriatrics and of hospital medicine at UCSF and the affiliated San Francisco VA Health Care System. "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."
Breast cancer surgery is the most common cancer operation performed in nursing home residents, constituting 61 percent of procedures. More than half of female nursing home residents are identified with suspected breast cancer through screening or physical exam, and about two-thirds of those are referred for diagnosis or treatment.
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