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

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.

Comprehensive Geriatric Assessment for Older Women with Early-Stage (Non-Metastatic) Breast Cancer—An Updated Systematic Review of the Literature

“…The ability to estimate mortality following an intervention is extremely important in the setting of breast cancer at diagnosis, where a range of treatment options exist [ 30 ]. Although breast cancer surgery is deemed less morbid than surgery for other types of cancers, other studies have shown that functional status does decline after breast cancer surgery and severity of decline is associated with extent of surgery [ 31 ].…”

Effect of Multimodal Exercise Program on Functional Outcome, Fatigue and Emotional Health in Mastectomy Patient with Concomitant Rheumatoid Arthritis: A Case Study

“…Studies have reported a negative impact of mastectomy on the functional independence of the patient. More extensive surgery and co-morbidities may predict subsequent functional decline [12]. Following mastectomy, musculoskeletal complications such as pain, reduced joint mobility and reduced muscle strength cause functional decline.…”

Oncoplastic breast surgery in older women with primary breast cancer: systematic review

“…The benefits of OBS are manifold, and include reducing the need for more extensive surgery with mastectomy and reconstruction, along with improvements in aesthetic and quality-of-life outcomes 10–13 . Studies 14 , 15 have shown that functional status can decline after breast cancer surgery, and this is compounded by the intensity of the surgery itself. Therefore, OBS may be better than mastectomy with reconstruction in preserving functional status in older women.…”