Women with early stage breast cancer experience functional decline after treatment

In a study of older women with newly diagnosed stage I to III breast cancer, approximately one in five lost the ability to complete some of the basic tasks necessary for independent living within one year of initiating treatment. The study also found that a simple survey can help identify which women are at risk of such functional decline. The findings are published early online in Cancer, a peer-reviewed journal of the American Cancer Society.

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.

Because preventing functional decline could provide a number of benefits, it is important to identify which patients are most vulnerable. Cynthia Owusu, MD, MS, of Case Western Reserve University in Cleveland, and her colleagues attempted to do so in a group of 184 women aged 65 years and older who had been recently diagnosed with stage I to III breast cancer. The researchers used the Vulnerable Elders Survey, a 13-item self-administered tool that has been validated in community-dwelling elders to predict functional decline or death within 12 months. Patients completed the survey just prior to breast cancer treatment.

Within 12 months, 34 of the 184 patients developed functional decline and seven died. The risk of functional decline or death rose with increasing survey scores. Women without an education beyond high school were disproportionately affected.

"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," said Dr. Owusu. "Such efforts may in the long term translate to improved treatment tolerance and better breast cancer outcomes."