Owusu Cynthia, Margevicius Seunghee, Schluchter Mark, Koroukian Siran M, Schmitz Kathryn H, Berger Nathan A
Division of Hematology/Oncology, Department of Medicine, Case Western Reserve School of Medicine, Cleveland, Ohio.
Case Comprehensive Cancer Center, Cleveland, Ohio.
Cancer. 2016 Aug 15;122(16):2579-86. doi: 10.1002/cncr.30046. Epub 2016 Jun 27.
The purpose of this study was to determine the ability of the Vulnerable Elders Survey (VES-13) to predict the composite outcome of functional decline and death within 12 months of breast cancer treatment among women 65 years old or older with newly diagnosed stage I to III breast cancer.
Two hundred and six participants were recruited from ambulatory oncology clinics at an academic center between April 2008 and April 2013. Participants competed the VES-13 at baseline just before neoadjuvant/adjuvant treatment. The primary outcome, functional decline/death, was defined as either a decrease of at least 1 point on the Activities of Daily Living scale and/or the Instrumental Activities of Daily Living scale or death between baseline and 12 months (yes or no).
One hundred and eighty four participants (89%) completed 12 months of follow-up. Twenty-two percent functionally declined (n = 34) or died (n = 7). Univariately, with increasing VES-13 scores, the estimated risk of functional decline/death rose from 23% for participants with a VES-13 score of 3 to 76% for participants with a VES-13 score of 10. In multivariate logistic regression analysis, VES-13 scores (adjusted odds ratio, 1.37; 95% confidence interval, 1.18-1.57) and having a high school education or less (adjusted odds ratio, 2.47; 95% confidence interval, 1.08-5.65) were independent predictors of functional decline/death (area under the receiver operator curve, 0.79).
Among older women with newly diagnosed nonmetastatic breast cancer, approximately 1 in 5 functionally declined and/or died within 12 months of breast cancer treatment initiation. Women with high school education or less were disproportionately affected. The VES-13 is a useful instrument for the early identification of those at risk for functional decline and/or death. Cancer 2016;122:2579-86. © 2016 American Cancer Society.
本研究旨在确定脆弱老年人调查（VES - 13）预测65岁及以上新诊断为I至III期乳腺癌的女性在乳腺癌治疗12个月内功能衰退和死亡这一复合结局的能力。
2008年4月至2013年4月期间，从一所学术中心的门诊肿瘤诊所招募了206名参与者。参与者在新辅助/辅助治疗前的基线期完成了VES - 13调查。主要结局，即功能衰退/死亡，定义为在日常生活活动量表和/或工具性日常生活活动量表上至少下降1分，和/或在基线期至12个月之间死亡（是或否）。
184名参与者（89%）完成了12个月的随访。22%的参与者出现功能衰退（n = 34）或死亡（n = 7）。单因素分析显示，随着VES - 13评分的增加，功能衰退/死亡的估计风险从VES - 13评分为3的参与者的23%上升至VES - 13评分为10的参与者的76%。在多因素逻辑回归分析中，VES - 13评分（调整后的优势比，1.37；95%置信区间，1.18 - 1.57）以及高中及以下学历（调整后的优势比，2.47；95%置信区间，1.08 - 5.65）是功能衰退/死亡的独立预测因素（受试者工作特征曲线下面积，0.79）。
在新诊断为非转移性乳腺癌的老年女性中，约五分之一的女性在乳腺癌治疗开始后的12个月内出现功能衰退和/或死亡。高中及以下学历的女性受影响尤为严重。VES - 13是早期识别功能衰退和/或死亡风险人群的有用工具。《癌症》2016年；122:2579 - 86。©2016美国癌症协会。
