Nottingham Breast Cancer Research Centre, University of Nottingham, UK.
Nottingham Breast Cancer Research Centre, University of Nottingham, UK.
Eur J Surg Oncol. 2021 Aug;47(8):1891-1899. doi: 10.1016/j.ejso.2021.04.010. Epub 2021 Apr 14.
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.
原发性内分泌治疗作为乳腺癌的治疗方法仅推荐用于预期寿命有限的老年女性。然而，许多老年女性由于担心虚弱和手术后功能潜在下降而选择内分泌治疗。一些癌症类型（如结直肠癌）手术后功能状态下降的情况有记录，但乳腺癌手术的全部影响则了解较少。进行了一项系统评价，以研究乳腺癌手术对老年女性功能状态的影响。检索了 PubMed 和 Embase 数据库。如果研究在过去 10 年内进行；纳入年龄超过 65 岁接受乳腺癌手术的患者；对结果按年龄分层；在术前和术后至少 6 个月测量功能状态，则研究符合纳入标准。共评估了 11 项研究，共纳入 12030 名女性。有两项研究为 II 级证据，九项为 IV 级证据。总体而言，乳腺癌手术会降低身体活动水平，手术范围越大，影响越严重。乳腺癌手术对生活质量、疲劳和认知的影响证据相互矛盾。所有考虑手术的老年女性都应讨论乳腺癌手术后功能状态下降的可能性。结构化的锻炼计划可能会减轻手术对身体活动的负面影响。在生活质量、疲劳和认知等领域需要进一步的研究。
