S. K. Palfi1, J. Ngo1, N. Champion2, J. Whiting2, W. Sun2, C. Sam2, M. Lee2 1University Of South Florida College Of Medicine, Tampa, FL, USA 2Moffitt Cancer Center And Research Institute, Tampa, FL, USA
Introduction: With an increasingly geriatric population in the United States, breast cancer surgery in the elderly is now common practice. Previous studies have established malnutrition as a predictive factor for clinical outcomes in cancer patients. The Global Leadership Initiative on Malnutrition (GLIM) criteria for diagnosing malnutrition requires at least one phenotypical criterion, such as non-volitional weight loss or low body mass index (BMI) as well as the presence of at least one etiologic factor, i.e., disease burden. These patients are further classified as either moderate or severe malnutrition. Our hypothesis is that elderly breast cancer patients with malnutrition will exhibit significantly higher rates of post-surgical complications and mortality compared to the general population.
Methods: This is a single-institution retrospective review of a prospective database of geriatric patients receiving surgery for stage 0-III breast cancer. Clinical data were used to determine malnutrition status at presentation, 90-day post-operative complication rates and 5-year survival. Complications were subdivided into serious (sepsis, deep vein thrombosis, myocardial infarction, cerebrovascular attack, upgrade to ICU, re-intubation) and any (hematoma, surgical site infection, wound dehiscence). Patient demographics, BMI, surgical outcomes, and mortality were analyzed using Chi-Square or Fisher’s exact tests, Kruskal-Wallis tests, Kaplan Meier survival curves, Univariate cox model with statistical significance of two-sided p≤0.05.
Results: Of 436 patients with mean age of 77.1 years (range 62.0 to 101), malnutrition was observed in 69 (15.8%) patients, with 40 (18.78%) >80 years of age. Of the total sample, 66 (15.1%) had moderate malnutrition, and 3 (0.7%) had severe malnutrition; 40 (9.2%) received a nutrition consult. 166 (38.4%) patients had mastectomy and 266 (61.6%) had lumpectomy. There was no significant difference in rates of malnutrition between lumpectomy and mastectomy patients (p=0.186). 43 (9.9%) patients had postoperative complications; this was not associated with nutritional status (p = 0.723) or type of surgery. Patients with age <80 who were not malnourished had higher rates of serious complications (7.73%, p=0.010). On univariate cox model analysis, patients <80 had better 5-year survival compared to patients with age ≥80 (p<0.001), but no significant difference between patients between nutrition status (p=0.404).
Conclusion: In this cohort, malnutrition based on GLIM criteria was identified in over 15% of geriatric breast cancer patients. Unlike age, this was not predictive of post-breast surgery outcomes or 5-year survival. Further evaluation in a larger cohort may be warranted.
