In a cohort study reported in a research letter in JAMA Surgery, Minami et al found that frailty status worsened in a sizable proportion of older patients receiving locoregional therapy—including lumpectomy or mastectomy—for early-stage breast cancer. Baseline robust status and mastectomy were associated with an increased risk of worsened frailty status.
Study Details
The study included women aged ≥ 65 years with ductal carcinoma in situ (DCIS) or stage I hormone receptor–positive and HER2-positive breast cancer in the Surveillance, Epidemiology, and End Results (SEER) and linked Medicare database who underwent locoregional therapy between January 2010 and October 2015. Frailty status was assessed by a claims-based frailty index over the period from diagnosis to 1 year postdiagnosis.
Key Findings
The analysis included 31,084 women (median age = 73 years); of these, 22.6% underwent mastectomy and 77.4% underwent lumpectomy.
At diagnosis, 55.6% of patients were robust (54.6% of mastectomy group and 55.9% of lumpectomy group), 40.3% had prefrailty (40.7% and 40.2%), 3.8% had mild frailty (4.2% and 3.6%), and 0.3% had moderate/severe frailty (0.4% and 0.2%).
Worsening frailty status occurred in 21.4% of patients, including 24.8% of the mastectomy group and 20.4% of the lumpectomy group.
In adjusted analysis, factors significantly associated with worsened frailty status were:
- Mastectomy vs lumpectomy (odds ratio [OR] = 1.31, 95% CI = 1.23–1.39)
- Robust status vs moderate/severe frailty at baseline (OR = 6.12, 95% CI = 2.80–13.35)
- Age 75 to 79 years (OR = 1.21, 95% CI = 1.12–1.31), 80-84 years (OR = 1.53, 95% CI = 1.40–1.66) and ≥ 85 years (OR = 1.94, 95% CI = 1.75–2.13) vs 65 to 69 years
- Black vs White race (OR = 1.12, 95% CI = 1.01–1.24).
The investigators stated, “We found that 4.1% of women aged 65 years or older with DCIS [or] stage I breast cancer had frailty at diagnosis, but 21.4% experienced clinically significant decline. Those who had robustness at diagnosis and those who underwent mastectomy had significantly higher odds of decline. Tailoring locoregional therapy intensity in this population is important as clinical trial data have shown equivalent survival between lumpectomy and mastectomy and that radiotherapy and axillary surgery can be safely omitted in older adults with early-stage [hormone receptor–]positive disease. That women in the robust category were more likely to develop frailty after locoregional therapy suggests that thoughtful treatment decisions should be undertaken in all older women, not simply those who have frailty at diagnosis.”
Christina A. Minami, MD, MS, of the Breast Oncology Program, Dana-Farber/Brigham and Women’s Cancer Center, is the corresponding author for the JAMA Surgery article.
Disclosure: The study was funded by the Brigham and Women’s Hospital Department of Surgery’s Beal Fellowship. For full disclosures of the study authors, visit jamanetwork.com.
