Watch for functional decline in older women starting treatment for early stage breast cancer

Within 1 year of initiating treatment, nearly 1 in 5 older women with newly diagnosed stage I to III breast cancer have undergone functional decline, and lost their ability to complete some basic tasks of independent living, according to a study published online in Cancer. A simple survey, the Vulnerable Elders Survey (VES-13), however, can help clinicians identify which women are at risk.

For this study, 206 women were recruited from ambulatory oncology clinics between April 2008 and April 2013, and were asked—prior to initiating treatment for breast cancer—to complete the 13-item self-administered Vulnerable Elders Survey, which was designed to predict functional decline or death within 12 months. Of these, 184 women aged ≥ 65 years recently diagnosed with stage I-III breast cancer completed the 12-month follow-up.

As survey scores increased, so did the risk of functional decline or death. In a 12-month period, 22% had functionally declined, and 7 died. Upon univariate analysis, lead author Cynthia Owusu, MD, MS, of University Hospitals Seidman Cancer Center and Case Western Reserve University School of Medicine, Cleveland, OH, and colleagues found that the estimated risk of functional decline/death increased from 23% for those with a score of 3, to 76% for a score of 10.

Upon multivariate logistic regression analysis, they found that independent predictors of functional decline or death (area under receiver operator curve: 0.79) included these VES-13 scores (adjusted OR [AOR]: 1.37; 95% CI, 1.18-1.57) and having a high school education or less (AOR: 2.47; 95% CI, 1.08-5.65).

“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,” she added.