Impact of Dementia on treatment of older patients with breast cancer. An interim analysis of the Bridging the Age Gap in Breast Cancer Study


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Osama Zaman1,Sue Ward2,Karen Collins3,Kwok-Leung Cheung4,Thompson Robinson5,Riccardo Audisio6,Oscar Bortolami7,Charlene Martin7,Malcolm Reed8,Lynda Wyld7
1University of Sheffield Medical School,2ScHARR, University of Sheffield,3Sheffield Hallam University,4The University of Nottingham,5University of Leicester,6University of Liverpool,7The University of Sheffield,8Brighton and Sussex Medical School

Abstract

Background

One third of all breast cancer cases occur in women over 70 in whom co-morbidity rates may be higher than younger patients. Seven percent of women aged over 65 have dementia and so the two conditions often co-exist.  Dementia is associated with a reduced life expectancy and increases the risk of acute or chronic post-operative cognitive dysfunction after surgery.  This study has examined the impact of dementia on women with early breast cancer in terms of treatment decisions and post-operative complications. 

 

Method

The Age Gap study is a large, multicentre, prospective cohort study of older women with early breast cancer. Interim comparison of treatment allocation and surgical complications in women with and without a clinical or MMSE confirmed diagnosis of dementia, was performed. Comparison of rates of surgery in women with and without dementia was assessed via simple logistic regression. Surgically treated patients with or without dementia were compared using Chi2 to detect any association between the presence or absence of dementia and incidence of local and systemic complications.

Results

Data was available for 1965 patients recruited between April 2013 and December 2015, from 51 UK hospitals.  Of these 207 (10.5%) had dementia. Median age of the patient cohort was 77 years (70 - 101). Patients with dementia were 66% less likely to receive surgery than those without dementia (OR 0.344, 95% CI 0.249 – 0.473, p < 0.001). In patients undergoing surgery, dementia was not a significant predictor of local (p<0.16) or systemic (p<0.84) complications. 

Conclusion

This study suggests that whilst older patients with dementia seem to tolerate surgery well, they are significantly less likely to undergo breast cancer surgery.  Whether this will translate into higher breast cancer specific mortality in dementia patients is unknown, although overall survival in dementia patients is known to be reduced.