Simple questions predict decline after breast cancer treatment

(Reuters Health) – Within one year of starting treatment, many older women with early stage breast cancer lose the ability to complete some tasks of daily living, and a 13-item survey can help predict who they will be, researchers say.

The study of U.S. breast cancer patients found one in five women lost functional abilities necessary to living independently in the community and at home, said lead author Dr. Cynthia Owusu of Case Western Reserve University in Cleveland, Ohio.

Scores on the survey, which was originally developed to predict decline in elderly people without cancer, strongly predicted who would be most affected a year later. The rate of decline among these breast cancer patients is higher than has been found in studies from non-cancer patients, Owusu noted.

The researchers analyzed data on 184 women 65 to 93 years old and newly diagnosed with breast cancer that had not spread to another area of the body. Each was recruited shortly after her diagnosis but before cancer treatment had begun.

Every participant was given the Vulnerable Elders Survey (VES-13), which includes 13 questions about the person’s sense of their own health and their ability to lift heavy objects, grasp small objects, write, walk a quarter mile, do housework or shopping, manage money and perform other activities of independent living. The maximum VES-13 score is 10, with higher scores indicating higher risk of decline.

Researchers also gave participants other questionnaires designed to gauge their ability to complete activities of daily living and overall functional status. These were repeated six months after enrollment and again at 12 months.

At the one-year mark, 34 women had experienced functional decline and seven died, representing 22 percent of the original group. Those who had the highest scores on the VES-13 were most likely to experience decline, according to the results published in Cancer.

Women with a score of 3 on the VES-13 test at the start, for example, had a 23 percent likelihood of declining a year later, while that rose to 76 percent with a VES-13 score of 10.

The other independent predictor of decline was having a high school education or less, researchers found.

Functional decline in these cases may be due to both the cancer itself and cancer treatments, Owusu told Reuters Health by email.

“Functional status is a key summary measure of health,” she said. “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,” and puts a huge financial burden on the individual and society at large, she said.

“For that reason, the prevention of functional decline in this population could be significant with potential benefits at both the individual and societal level, and could potentially improve overall survival for older women with breast cancer, particularly for women of lower socioeconomic status,” Owusu said.

People of lower socioeconomic status tend to have higher rates of obesity, be less physically active and more often have multiple medical conditions to contend with, which all contribute to functional decline, she noted.

Using the simple 13-question survey in this study helped predict which women would experience functional decline, and exercise can help prevent it, Owusu said.

“Design and development of exercise programs for older women with breast cancer, particularly for women of lower socioeconomic status, will be helpful,” she said.

SOURCE: Cancer, online June 27, 2016.