Quality of life of elderly women with early breast cancer following surgery


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Anne Shrestha1,Charlene Martin1,Karen Collins2,Maria Burton2,Riccardo Audisio3,Tim Chater1,Kirsty Pemberton1,Kl Cheung4,Sue Ward1,Stephen Walters1,Reed Malcolm5,Tg Robinson6,T Green1,Dierdre Revell7,Jaqui Gath8,Lynda Wyld1
1University of Sheffield,2Hallam University,3St Helens and Knowsley Hospitals NHS Trust,4Nottingham University,5Brighton and Sussex Medical School,6University of Leicester,7Patient Advocate,8Patient advocate

Abstract

Background

Management of older women with breast cancer may be  challenging due to co-morbidities and frailty, limiting treatment options. Primary endocrine therapy may be offered instead of surgery due to possible surgical and anaesthetic risks. Quality of life (QoL) is increasingly recognised as an important cancer outcome. We aimed to assess the impact of breast surgery on short and longer term QoL in older women.

Method

‘Bridging the Age Gap’ is a multicentre prospective longitudinal observational study of women >70 years, with operable breast cancer, measuring QoL before  and after  treatment. Patients who underwent surgery (breast conserving or mastectomy +/- axillary surgery) and completed validated QoL instruments (EORTC-QLQ-C30, BR23 and ELD14) at 0, 12, 18 and 24 months were included. A paired t-test was used to compare QoL scores relative to the pre-treatment baseline. 

Results

2923 women were recruited from across 53 UK breast units between February 2012 and May 2017. 407 patients completed all 3 questionnaires at the specified intervals. Median age was 76.1 (70.2 – 92.5) at baseline. Global QoL scores declined relative to baseline and never recovered to the pre-treatment baseline after cancer surgery. Mean scores were 77, 74, 72 and 71 at 0, 12, 18 and 24 months respectively, all were significantly different to the baseline score. The physical function and role function domains showed the most significant decline (p<0.0001). Emotional function and future perspectives improved between 0 to 12 months. Reduction in cognitive function and social function were noted at 12 months, plateauing at 18 and 24 months. Concerns regarding body image were significant at 12 months but declined thereafter.

Conclusion

Patients’ experienced reduced QoL following surgery for breast cancer. Older patients are less likely to regain their physical baseline status post-surgical management, however, their mental outlook remained positive.