Same-day discharge pathway for breast cancer surgery in patients aged over 80: A feasibility study

Abstract

The therapeutic strategy in older adults with breast cancer (BC) has always sought to be a model of personalized medicine. The first example was primary endocrine therapy, a less aggressive treatment targeting a biomarker in a frail patient [ [1] Preece P.E. Wood R.A. Mackie C.R. Cuschieri A. Tamoxifen as initial sole treatment of localised breast cancer in elderly women: a pilot study. Br Med J (Clin Res Ed). 1982 Mar 20; 284: 869-870https://doi.org/10.1136/bmj.284.6319.869-a Crossref PubMed Scopus (154) Google Scholar ]. Recently, there have been further proposals to de-escalate surgical procedures, to the extreme of considering omitting surgery altogether [ [2] LeMasters T.J. Madhavan S.S. Sambamoorthi U. Vyas A.M. Disparities in the initial local treatment of older women with early-stage breast Cancer: a population-based study. J Womens Health (Larchmt). 2017 Jul; 26: 735-744https://doi.org/10.1089/jwh.2015.5639 Crossref Scopus (10) Google Scholar , [3] Matar R. Barrio A.V. Sevilimedu V. Le T. Heerdt A. Morrow M. et al. Can we successfully De-escalate axillary surgery in women aged ≥ 70 years with ductal carcinoma in situ or early-stage breast Cancer undergoing mastectomy?. Ann Surg Oncol. 2022 Apr; 29: 2263-2272https://doi.org/10.1245/s10434-021-11140-5 Crossref Scopus (1) Google Scholar ]. However, studies have found a negative impact of omission of surgery on survival and quality-of-life in older patients[ 4 Ward S.E. Richards P.D. Morgan J.L. Holmes G.R. Broggio J.W. Collins K. et al. Omission of surgery in older women with early breast cancer has an adverse impact on breast cancer-specific survival. Br J Surg. 2018 Oct; 105: 1454-1463https://doi.org/10.1002/bjs.10885 Crossref PubMed Scopus (25) Google Scholar , 5 Wyld L. Reed M.W.R. Morgan J. Collins K. Ward S. Holmes G.R. et al. Bridging the age gap in breast cancer. Impacts of omission of breast cancer surgery in older women with oestrogen receptor positive early breast cancer. A risk stratified analysis of survival outcomes and quality of life. Eur J Cancer. 2021 Jan; 142: 48-62https://doi.org/10.1016/j.ejca.2020.10.015 Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar , 6 Osório F. Barros A.S. Peleteiro B. Barradas A.R. Urbano J. Fougo J.L. et al. Frailty-independent Undertreatment negative impact on survival in older patients with breast Cancer. J Breast Cancer. 2021 Dec; 24: 542-553https://doi.org/10.4048/jbc.2021.24.e45 Crossref Scopus (1) Google Scholar ].