Tang V, et al. - In female nursing home residents stratified by surgery type, researchers evaluated the overall survival and functional status changes after breast cancer surgery. There was high 30-day mortality and survival as well as 1-year mortality and functional decline for female nursing residents undergoing breast cancer surgery. Findings revealed that the 1-year survivors had significant functional decline. The findings of this study suggest that this information should be included in collaborative surgical decision-making processes.

Methods

• Using Medicare claims from 2003 to 2013, researchers identified 5969 US nursing home residents who underwent inpatient breast cancer surgery.
• This investigation investigated preoperative and postoperative function and identified patient characteristics associated with 30-day and 1-year mortality and 1-year functional decline after surgery using the Minimum Data Set Activities of Daily Living (MDS-ADL) summary score.
• To estimate unadjusted and adjusted hazard ratios (HRs) of mortality, Cox proportional hazards regression was used.
• To estimate unadjusted and adjusted subhazard ratios (sHRs) of functional decline, Fine-Gray competing risks regression was used.
• From January 2016 to January 2018, statistical analysis was performed.
• Main outcome and measure included functional status and death.

Results

• A total of 5969 female nursing home residents (mean [SD] age, 82 [7] years; 4960 [83.1%] white) underwent breast cancer surgery from 2003 to 2013: 666 (11.2%) underwent lumpectomy, 1642 (27.5%) underwent mastectomy, and 3661 (61.3%) underwent lumpectomy or mastectomy with axillary lymph node dissection (ALND).
• Findings revealed that the 30-day mortality rates were 8% after lumpectomy, 4% after mastectomy, and 2% after ALND.
• It was noted that the 1-year mortality rates were 41% after lumpectomy, 30% after mastectomy, and 29% after ALND.
• The functional decline rate was 56% to 60% among 1-year survivors.
• Investigators observed that the mean MDS-ADL score increased (signifying greater dependency) by 3 points for lumpectomy, 4 points for mastectomy, and 5 points for ALND.
• Poor baseline MDS-ADL score (range, 20-28) was related to a higher 1-year mortality risk (lumpectomy: HR, 1.92 [95% CI, 1.23-3.00], P=.004; mastectomy: HR, 1.80 [95% CI, 1.35-2.39], P < .001; and ALND: HR, 1.77 [95% CI, 1.46-2.15], P < .001) in multivariate analysis.
• Preoperative decline in MDS-ADL score (lumpectomy: sHR, 1.59 [95% CI, 1.25-2.03], P < .001; mastectomy: sHR, 1.79; [95% CI, 1.52-2.09], P < .001; and ALND: sHR, 1.72 [95% CI, 1.56-1.91], P < .001) and cognitive impairment (lumpectomy: sHR, 1.27 [95% CI, 1.03-1.56], P=.02; mastectomy: sHR, 1.26 [95% CI, 1.09-1.45], P=.002; and ALND: sHR, 1.14 [95% CI, 1.04-1.24], P=.003) were significantly linked to 1-year functional decline across all breast cancer surgery groups after multivariate adjustment.