The trajectory of physical functioning during breast cancer treatment of older women.

Abstract

9129 Background: We sought to characterize the trajectory of physical functioning during the first 12 months following initial breast cancer diagnosis in older women with stage I-III breast cancer. Methods: Between April 2008 and March 2010 a cohort of women ≥65 years with incident stage I-III breast cancer, were enrolled into a prospective cohort study following primary surgery or prior to neoadjuvant chemotherapy. Participants completed a comprehensive geriatric assessment at study entry, six and 12 months. The primary end-points was mean change in the total Activities of Daily Living/Instrumental Activities of Daily Living (ADL/IADL) scores from baseline to six and 12 months, respectively. A decrease in ADL/IADL scores denoted functional decline. Results: Of sixty-one women enrolled, 48 completed baseline and 12th month CGA, four withdrew from the study, five were lost to follow-up and four have pending 12th month assessment as of 12/31/2010. This report includes the 48 evaluable women. The median age was 73 years, (inter-quartile range 68.5-80 years), 90% had stage I-II disease, 35% had node positive disease, 85% had hormone-receptor positive disease and 35% received adjuvant chemotherapy and/or trastuzumab. The mean change in ADL/IADL scores at six and 12 months was -0.58 [(sd=1.39), p= 0.008] and -0.85 [(sd=2.37), p= 0.02], respectively. The proportion of women who had a decrease, an increase or no change in ADL/IADL scores at six and 12 months from baseline were 24%, 5% and 71%, and 29%, 10% and 61%, respectively. Women with lower than high school education (46% vs. 14%, p=0.03), Karnofsky Performance Status scores ≤80% (67% vs. 17%, p=0.002), any IADL dependency (63% vs. 13%, p=0.0003), Timed-Up-and-Go Test time >14 seconds, (67% vs. 22%, p=0.05) and tumor size ≥ 2cm, (50% vs. 13%, p=0.01) at baseline were more likely to develop functional decline at 12 months. Conclusions: One out of every four older woman with breast cancer developed functional decline within six months of treatment increasing to almost one out of every three older woman by 12 months. Studies to identify biologic, molecular and clinical determinants of functional decline in older women with breast cancer in the adjuvant setting are warranted to inform remediation.