Frailty and Malnutrition in Surgical Outcomes of Elderly Breast Cancer Patients

ABSTRACT Introduction We evaluate the impact of frailty and malnutrition on breast cancer surgery outcomes in older adults using the ACS 5‐factor modified frailty index (MFI) and Global Leadership Initiative on Malnutrition (GLIM) definition. Methods Single institution retrospective review of a prospective database of the older adult (>60 years old) breast cancer surgery patients (2000–2016); cases stratified into groups as per MFI (0–2) and GLIM. Characteristics, 90‐day post‐op events, and 5‐year follow‐up data were analyzed to report survival and complication outcomes. Results Among 436 patients at diagnosis, 213 (48.9%) were >80 years old. 377 (86.5%) were alive at 5 years. 274 (62.8%) had MFI > 0, and 69 (15.8%) had malnutrition. Patients ≥ 80, MFI > 0, and PR‐negative tumors had worse 5‐year survival. There was no survival difference in patients >80 with/without malnutrition (HR = 1.01, p = 0.971), and there was no difference in mastectomy or lumpectomy ( p = 0.560) between patients ≥ 80 or patients younger than 80; however, 94% of immediate reconstruction were in pts < 80. On multivariate regression, complications were associated with age < 80, readmission, MFI > 0, and history of HTN; serious complications were associated with age < 80, readmission, anticoagulation, and not receiving endocrine therapy. Conclusion MFI showed a significant predictive value for 5‐year survival for patients ≥ 80 and should be part of the preoperative evaluation.