Postoperative complications and survival of elderly breast cancer patients: a FOCUS study analysis
- 568 Downloads
Old age is associated with comorbidity and decreased functioning which influences treatment decisions in elderly breast cancer patients. The purpose of this study was to identify risk factors for complications after breast cancer surgery in elderly patients, and to assess mortality in patients with postoperative complications. The FOCUS cohort is a detailed retrospective cohort of all breast cancer patients aged 65 years and older who were diagnosed between 1997 and 2004 in the South-West of the Netherlands. Risk factors for postoperative complications were assessed using univariable and multivariable logistic regression models. One-year survival and overall survival were calculated using univariable and multivariable Cox Regression models, and relative survival was calculated according to the Ederer II method. 3179 patients received surgery, of whom 19 % (n = 618) developed 1 or more postoperative complication(s). The odds ratio of having postoperative complications increased with age [OR 1.85 (95 % confidence interval (CI) 1.37–2.50, p = 0.001) in patients >85 years] and number of concomitant diseases [OR 1.71 (95 % CI 1.30–2.24, p ≤ 0.001) for 4 or more concomitant diseases]. One-year overall survival, overall survival, and relative survival were worse in patients with postoperative complications [multivariable HR 1.49 (95 % CI 1.05–2.11), p = 0.025. HR 1.21, (95 % CI 1.07–1.36), p = 0.002 and RER 1.19 (95 % CI 1.05–1.34), p = 0.006 respectively]. Stratified for comorbidity, relative survival was lower in patients without comorbidity only. Increasing number of concomitant disease increased the risk of postoperative complications. Although elderly patients with comorbidity did have a higher risk of postoperative complications, relative mortality was not higher in this group. This suggests that postoperative complications in itself did not lead to higher relative mortality, but that the high relative mortality was most likely due to geriatric parameters such as comorbidity or poor physical function.
KeywordsBreast cancer Elderly Breast surgery Postoperative complications Comorbidity Geriatric oncology
This work was supported by the Dutch Cancer Foundation (KWF 2007-3968). The authors would like to thank the Comprehensive Cancer Centre Netherlands (Leiden region), all participating hospitals and M. Murk-Jansen for data collection.
Conflict of interest
The authors declare that they have no conflict of interest.
Data collection complies with the current laws of the Netherlands.
- 1.Wildiers H, Kunkler I, Biganzoli L, Fracheboud J, Vlastos G, Bernard-Marty C, Hurria A, Extermann M, Girre V, Brain E, Audisio RA, Bartelink H, Barton M, Giordano SH, Muss H, Aapro M (2007) Management of breast cancer in elderly individuals: recommendations of the international society of geriatric oncology. Lancet Oncol 8:1101–1115PubMedCrossRefGoogle Scholar
- 3.Braithwaite D, Satariano WA, Sternfeld B, Hiatt RA, Ganz PA, Kerlikowske K, Moore DH, Slattery ML, Tammemagi M, Castillo A, Melisko M, Esserman L, Weltzien EK, Caan BJ (2010) Long-term prognostic role of functional limitations among women with breast cancer. J Natl Cancer Inst 102:1468–1477PubMedCrossRefGoogle Scholar
- 4.Bastiaannet E, Liefers GJ, de Craen AJ, Kuppen PJ, van de Water W, Portielje JE, van der Geest LG, Janssen-Heijnen ML, Dekkers OM, van de Velde CJ, Westendorp RG (2010) Breast cancer in elderly compared to younger patients in the Netherlands: stage at diagnosis, treatment and survival in 127,805 unselected patients. Breast Cancer Res Treat 124:801–807PubMedCrossRefGoogle Scholar
- 5.van de Water W, Markopoulos C, van de Velde CJ, Seynaeve C, Hasenburg A, Rea D, Putter H, Nortier JW, de Craen AJ, Hille ET, Bastiaannet E, Hadji P, Westendorp RG, Liefers GJ, Jones SE (2012) Association between age at diagnosis and disease-specific mortality among postmenopausal women with hormone receptor-positive breast cancer. JAMA 307:590–597PubMedCrossRefGoogle Scholar
- 6.Biganzoli L, Wildiers H, Oakman C, Marotti L, Loibl S, Kunkler I, Reed M, Ciatto S, Voogd AC, Brain E, Cutuli B, Terret C, Gosney M, Aapro M, Audisio R (2012) Management of elderly patients with breast cancer: updated recommendations of the international society of geriatric oncology (SIOG) and European society of breast cancer specialists (EUSOMA). Lancet Oncol 13:e148–e160PubMedCrossRefGoogle Scholar
- 7.National Comprehensive Cancer Network (NCCN) (2013) NCCN Guidelines Version 1.2013; Senior Adult Oncology. http://www.nccn.org/professionals/physician_gls/pdf/senior.pdf. Accessed 4 Feb 2013
- 16.World Health Organization (1992) The ICD-10 classification of mental and behavioural disorders. WHO, Geneva, pp 1–267Google Scholar
- 20.de BC, Ogunleye AA, Momoh AO, Colakoglu S, Tobias AM, Sharma R, Houlihan MJ, Lee BT (2012) High body mass index and smoking predict morbidity in breast cancer surgery: a multivariate analysis of 26,988 patients from the national surgical quality improvement program database. Ann Surg 255:551–555CrossRefGoogle Scholar