Breast Cancer Surgery Outcomes Poor for Nursing Home Residents
TUESDAY, Sept. 4, 2018 -- For female nursing home residents who undergo breast cancer surgery, rates of one-year mortality and functional decline are high, according to a study published online Aug. 29 in JAMA Surgery.
Victoria Tang, M.D., from the University of California in San Francisco, and colleagues used Medicare claims from 2003 to 2013 to identify 5,969 U.S. nursing home residents who underwent inpatient breast cancer surgery. Overall survival and functional status changes after surgery were examined.
The researchers found that 11.2 percent of the participants underwent lumpectomy, 27.5 percent underwent mastectomy, and 61.3 percent underwent lumpectomy or mastectomy with axillary lymph node dissection (ALND). The 30-day mortality rates were 8, 4, and 2 percent, respectively, while one-year mortality rates were 41, 30, and 29 percent, respectively. The functional decline rate was 56 to 60 percent among one-year survivors. In multivariate analysis, a poor baseline Minimum Data Set Activities of Daily Living (MDS-ADL) score was associated with a higher one-year mortality risk for each surgery type (lumpectomy: hazard ratio, 1.92; mastectomy: hazard ratio, 1.8; and ALND: HR,hazard ratio 1.77). Preoperative decline in MDS-ADL score and cognitive impairment were significantly associated with one-year functional decline across all breast cancer surgery groups.
"This study's findings suggest that this information should be incorporated into collaborative surgical decision-making processes," the authors write.
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Posted: September 2018