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16-09-2021 | Breast cancer | Adis Journal Club | Article

Oncology and Therapy

Does Breast Cancer Surgery Impact Functional Status and Independence in Older Patients? A Narrative Review

Authors: Zoe Chia, Ruth M. Parks & Kwok-Leung Cheung

Abstract

Surgery is the recommended treatment modality for primary breast cancer. Breast cancer surgery is non-visceral; therefore, it is often assumed that the subsequent impact on functional status in older women is less significant compared to other cancer types such as colorectal cancer. Evidence for this however, is lacking. The definition of functional status varies amongst healthcare professionals and patients, making comparisons between studies difficult. From the literature, the two most common themes in relation to functional status following breast cancer surgery are activities of daily living and quality of life. Both of these elements of functional status are adversely impacted in patients following breast cancer surgery. A more significant decline is seen in patients with pre-existing comorbidities and with greater intensity of surgery, which includes more invasive breast and/or axillary surgery as well as additional reconstructive procedures. Identifying and optimising pre-existing factors which may predict post-operative decline in functional status, such as cognitive impairment and deteriorating functional decline over the preceding year, may help in reducing deterioration in functional status after breast cancer surgery. Methods which may be employed to detect and optimise these factors include geriatric assessment and exercise intervention.

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Key Summary Points

Breast cancer surgery is assumed to have minimal impact on the functional status of older women compared to other types of cancer surgery, for example, for intra-abdominal cancers.

There is evidence of a deterioration in the ability to perform activities of daily living and quality of life after breast cancer surgery in older women.

The level of deterioration is associated with pre-existing comorbidities and greater intensity of the surgical procedure.

As healthcare professionals, we must identify possible risk factors for decline in functional status pre-operatively and have frank discussions with our patients about how we can most appropriately deal with these and the possibility of irreversible decline.

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