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- DOI: 10.1002/bjs.9796
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Pre-treatment health measures and complications after surgical management of elderly patients with breast cancer
Lavelle, K; Sowerbutts, AM; Bundred, N; Pilling, M; Todd, C
British Journal of Surgery. 2015;102(6):653-667.
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Full-text held externally
- DOI: 10.1002/bjs.9796
Abstract
Introduction: Elderly breast cancer patients are less likely to be offered surgery, which in part is due to co-morbidities and reduced functional ability. However, there is little consensus on how best to assess surgical risk for this patient group. Methods: The ability of pre-treatment health measures to predict complications was investigated in a prospective cohort study of a consecutive series of 664 women aged â‰Â¥70 years undergoing surgery for operable (stage 1-3a) breast cancer at 22 English breast units between the years 2010-2013. Data on treatment, surgical complications, health measures and tumour characteristics were collected by case note review and/or patient interview. Outcome measures were all complications and serious complications within 30 days of surgery. Results: One or more complications were experienced by 41% of the patients, these being predominantly seroma or primary/minor infections. 6.5% had serious complications. More extensive surgery predicted a higher number of complications but not serious complications. Older age did not predict complications. Several health measures were associated with complications in univariate analysis, and were included in multivariable analyses, adjusting for type/extent of surgery and tumour characteristics. In the final models pain predicted a higher count of complications (Incidence Rate Ratio 1.006, 95% CI:1.002-1.011). Fatigue (OR 1.019, 95% CI:1.006-1.033), low platelets (OR 4.189, 95% CI:1.025-17.123) and pulse rate (OR 0.957, 95% CI:0.926-0.990) predicted serious complications. Conclusion: Risk of serious complications from breast surgery for older patients is low. Surgical decisions should be based on patient fitness rather than age. Health measures that predict surgical risk were identified in multivariable models, but the effects were weak with 95% confidence intervals close to unity.