One in Five Older Women With Breast Cancer Had Functional Decline

About 1 in every 5 women aged older than 65 years who underwent treatment for early-stage breast cancer experienced a functional decline and/or died within 1 year of initiating treatment for the disease, according to the results of a study published in Cancer.

These results were measured using the Vulnerable Elders Survey (VES-13), a self-administered tool that can predict functional decline or death at 12 months. This tool showed that 22% of women in this study lost the ability to complete some of the basic tasks necessary for independent living within 1 year of initiating treatment.

“Notably, the study identified VES-13 scores and educational status as the only independent predictive factors associated with functional decline/death within 12 months of treatment initiation,” wrote researcher Cynthia Owusu, MD, of University Hospitals Seidman Cancer Center and Case Western Reserve University, and colleagues.

A person’s functional status is a key measure of health. Previous research has shown that functional decline is associated with a decreased likelihood of recovery from a serious illness, an increased likelihood of dying, and a reduced ability to tolerate cancer treatment. Functional decline also results in a significant financial burden on individuals and society at large.

The study included 206 women recruited from ambulatory cancer centers at academic centers from April 2008 to April 2013. The VES-13 was completed before patients began adjuvant or neoadjuvant treatment for early-stage breast cancer. Functional decline or death was defined as a decrease of at least one point on the Activities of Daily Living scale and/or the Instrumental Activities of Daily Living scale, or death from baseline to 1 year.

At 1 year, 184 women were available for follow-up. Among these women, 22% experienced functional decline (n = 34) or death (n = 7). Sixty-seven percent of women remained stable, and 14% of women had improvements in functional status.

There was a significant difference in the mean baseline VES-13 scores among women who experienced functional decline or death and those who did not (4.4 vs 1.7; P < .0001).

Multivariate analysis showed that each one-point increase in VES-13 score (adjusted odds ratio [OR], 1.37 [95% CI, 1.18–1.57]) and having a high school education or less (adjusted OR, 2.47 [95% CI, 1.08–5.65]) were both independent predictors of functional decline or death among this group of patients.

“Our findings are important because the study validates the Vulnerable Elders Survey as a useful tool for identifying older women with breast cancer who may be at increased risk for functional decline within a year of treatment initiation. This instrument offers the opportunity for early identification and will inform the development of interventions to prevent and address functional decline for those particularly at risk, such as women with low socioeconomic status,” Owusu said in a press release. “Such efforts may in the long term translate to improved treatment tolerance and better breast cancer outcomes.”