Skip to main content


Log in

Postoperative complications and survival of elderly breast cancer patients: a FOCUS study analysis

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript


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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others


  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 8:1101–1115

    Article  PubMed  Google Scholar 

  2. Guralnik JM (1996) Assessing the impact of comorbidity in the older population. Ann Epidemiol 6:376–380

    Article  PubMed  CAS  Google 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 102:1468–1477

    Article  PubMed  Google 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 124:801–807

    Article  PubMed  CAS  Google 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 307:590–597

    Article  PubMed  Google 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–e160

    Article  PubMed  Google Scholar 

  7. National Comprehensive Cancer Network (NCCN) (2013) NCCN Guidelines Version 1.2013; Senior Adult Oncology. Accessed 4 Feb 2013

  8. van de Water W, Bastiaannet E, Dekkers OM, de Craen AJ, Westendorp RG, Voogd AC, van de Velde CJ, Liefers GJ (2012) Adherence to treatment guidelines and survival in patients with early-stage breast cancer by age at diagnosis. Br J Surg 99:813–820

    Article  PubMed  Google Scholar 

  9. Lavelle K, Todd C, Moran A, Howell A, Bundred N, Campbell M (2007) Non-standard management of breast cancer increases with age in the UK: a population based cohort of women > or = 65 years. Br J Cancer 96:1197–1203

    Article  PubMed  CAS  Google Scholar 

  10. Louwman WJ, Janssen-Heijnen ML, Houterman S, Voogd AC, van der Sangen MJ, Nieuwenhuijzen GA, Coebergh JW (2005) Less extensive treatment and inferior prognosis for breast cancer patient with comorbidity: a population-based study. Eur J Cancer 41:779–785

    Article  PubMed  CAS  Google Scholar 

  11. Land LH, Dalton SO, Jensen MB, Ewertz M (2012) Impact of comorbidity on mortality: a cohort study of 62,591 Danish women diagnosed with early breast cancer, 1990–2008. Breast Cancer Res Treat 131:1013–1020

    Article  PubMed  Google Scholar 

  12. Zulman DM, Sussman JB, Chen X, Cigolle CT, Blaum CS, Hayward RA (2011) Examining the evidence: a systematic review of the inclusion and analysis of older adults in randomized controlled trials. J Gen Intern Med 26:783–790

    Article  PubMed  Google Scholar 

  13. Vitug AF, Newman LA (2007) Complications in breast surgery. Surg Clin N Am 87:431–451

    Article  PubMed  Google Scholar 

  14. Janssen-Heijnen ML, Maas HA, Houterman S, Lemmens VE, Rutten HJ, Coebergh JW (2007) Comorbidity in older surgical cancer patients: influence on patient care and outcome. Eur J Cancer 43:2179–2193

    Article  PubMed  Google Scholar 

  15. Houterman S, Janssen-Heijnen ML, Verheij CD, Louwman WJ, Vreugdenhil G, van der Sangen MJ, Coebergh JW (2004) Comorbidity has negligible impact on treatment and complications but influences survival in breast cancer patients. Br J Cancer 90:2332–2337

    PubMed  CAS  Google Scholar 

  16. World Health Organization (1992) The ICD-10 classification of mental and behavioural disorders. WHO, Geneva, pp 1–267

  17. Patnaik JL, Byers T, Diguiseppi C, Denberg TD, Dabelea D (2011) The influence of comorbidities on overall survival among older women diagnosed with breast cancer. J Natl Cancer Inst 103:1101–1111

    Article  PubMed  Google Scholar 

  18. Dignam JJ, Huang L, Ries L, Reichman M, Mariotto A, Feuer E (2009) Estimating breast cancer-specific and other-cause mortality in clinical trial and population-based cancer registry cohorts. Cancer 115:5272–5283

    Article  PubMed  Google Scholar 

  19. Winther LL, Cronin-Fenton D, Garne JP, Kroman N, Silliman R, Lash TL (2012) Predictors of re-operation due to post-surgical bleeding in breast cancer patients: a Danish population-based cohort study. Eur J Surg Oncol 38:407–412

    Article  Google 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 255:551–555

    Article  Google Scholar 

  21. Vandenbroucke JP (2004) When are observational studies as credible as randomised trials? Lancet 363:1728–1731

    Article  PubMed  Google Scholar 

  22. Hind D, Wyld L, Reed MW (2007) Surgery, with or without tamoxifen, vs tamoxifen alone for older women with operable breast cancer: cochrane review. Br J Cancer 96:1025–1029

    Article  PubMed  CAS  Google Scholar 

Download references


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.

Ethical standards

Data collection complies with the current laws of the Netherlands.

Author information

Authors and Affiliations


Corresponding author

Correspondence to G. J. Liefers.

Rights and permissions

Reprints and permissions

About this article

Cite this article

de Glas, N.A., Kiderlen, M., Bastiaannet, E. et al. Postoperative complications and survival of elderly breast cancer patients: a FOCUS study analysis. Breast Cancer Res Treat 138, 561–569 (2013).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: