Predicting postoperative complications and their impact on quality of life and functional status in older patients with breast cancer

Abstract

Background The percentage of older patients undergoing surgery for early-stage breast cancer has decreased over the past decade. This study aimed to develop a prediction model for postoperative complications to better inform patients about the benefits and risks of surgery, and to investigate the association between complications and functional status and quality of life (QoL). Methods Women aged at least 70 years who underwent surgery for Tis–3 N0 breast cancer were included between 2013 and 2018. The primary outcome was any postoperative complication within 30 days after surgery. Secondary outcomes included functional status and QoL during the first year after surgery, as assessed by the Groningen Activity Restriction Scale and the European Organisation for Research and Treatment of Cancer QLQ-C30 and QLQ-BR23 questionnaires. A prediction model was developed using multivariable logistic regression and validated externally using data from the British Bridging the Age Gap Study. Linear mixed models were used to assess QoL and functional status over time. Results The development and validation cohorts included 547 and 2727 women respectively. The prediction model consisted of five predictors (age, polypharmacy, BMI, and type of breast and axillary surgery) and performed well in internal (area under curve (AUC) 0.76, 95 per cent c.i. 0.72 to 0.80) and external (AUC 0.70, 0.68 to 0.72) validations. Functional status and QoL were not affected by postoperative complication after adjustment for confounders. Conclusion This validated prediction model can be used to counsel older patients with breast cancer about the postoperative phase. Postoperative complications did not affect functional status nor QoL within the first year after surgery even after adjustment for predefined confounders. Lay summary Surgery remains the standard of care for the majority of older patients with breast cancer. The percentage of older patients with breast cancer receiving surgery is decreasing. The reason for this decline is unknown, but it might be due to fear of complications. To better inform patients about the benefits and risks of surgery, the aim of this study was to develop a prediction model for complications after surgery. Another important aspect, especially for older adults with breast cancer, is quality of life, functional capacity, and ability to carry out daily tasks (functional status) after therapy. This study showed that quality of life and functional status did not decline after breast surgery, irrespective of the occurrence of postoperative complications.

Physical Function and Physical Activity in Older Breast Cancer Survivors: 5-Year Follow-Up from the Climb Every Mountain Study

“…This study used data from the prospective, multicenter observational Climb Every Mountain study, which has been previously described in detail. 5 , 6 In short, patients aged 70 years and older who underwent surgery for primary, in situ or stages I-III breast cancer were recruited from 9 Dutch hospitals between 2013 and 2018. At baseline, patients underwent a geriatric assessment as part of standard care and they were followed up at 3, 9, 15, 27, and 60 months after surgery.…”

Prognostic Tools for Older Women with Breast Cancer: A Systematic Review

“…Another model predicting post-surgical outcomes for patients age ≥ 70 was developed by Lemij et al using data from 547 patients in the prospective multicenter Dutch CLIMB (Climb Every Mountain) cohort [ 17 ]. This model predicts the likelihood of developing postoperative complications, such as wound infection or seroma formation, in patients with non-metastatic breast cancer to allow for more tailored preoperative conversations.…”

“…Another interesting study was by Lemij et al, which reports on a model to predict the development of postoperative complications [ 17 ], a problem that is especially pertinent to the surgical management of older patients with breast cancer, although mortality from breast cancer related surgery is generally quite low [ 35 ]. However, this study had a high ROB due to participant selection.…”

Surgery is safe and improves survival in extremely old aged patients with breast cancer: A retrospective study

“…Because of the small sample size, the effects of radiotherapy on overall survival and local complications remain unexplored. More studies are emerging to develop prediction models for post‐operative complications in older patients with breast cancer 15 . With appropriate case selection, more older patients will benefit from surgery in terms of survival and minimizing debilitating local complications.…”