Abstract
Primary endocrine therapy as treatment of breast cancer is only recommended in older
women with limited life expectancy. However, many older women opt for endocrine therapy
due to concerns regarding frailty and potential decline in function after surgery.
A decline in functional status after surgery is documented in some cancer types, such
as colorectal, however, the full impact of breast cancer surgery is less understood.
A systematic review was performed to examine the evidence for impact of breast cancer
surgery on functional status in older women. PubMed and Embase databases were searched.
Studies were eligible if performed within the last 10 years; included patients over
the age of 65 years undergoing breast cancer surgery; included stratification of results
by age; measured functional status pre-operatively and at least six months following
surgery. A total of 11 studies including 12 030 women were appraised. Two studies
represented level-II and nine level-IV evidence. Overall, physical activity level
was negatively impacted by breast cancer surgery and this was compounded by the extent
of surgery. Evidence for impact of breast cancer surgery on quality of life, fatigue
and cognition, was conflicting. The possibility of decline in functional status after
breast cancer surgery should be discussed in all older women considering surgery.
A structured exercise program may improve the negative effects of surgery on physical
activity. Further work is required in the areas of quality of life, fatigability and
cognition.
Keywords
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Article info
Publication history
Published online: April 14, 2021
Accepted:
April 8,
2021
Received in revised form:
March 17,
2021
Received:
January 4,
2021
Identification
Copyright
© 2021 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
