title: Vulnerable elders survey and socioeconomic status predict functional decline and death among older women with newly diagnosed nonmetastatic breast cancer.
abstract: 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.
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Case Western Reserve School of Medicine, Cleveland, Ohio.|Case Comprehensive Cancer Center, Cleveland, Ohio.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Owusu
authors.affiliation: Case Comprehensive Cancer Center, Cleveland, Ohio.|Department of Epidemiology and Biostatistics, Case Western Reserve School of Medicine, Cleveland, Ohio.
authors.forename: Seunghee
authors.initials: S
authors.lastname: Margevicius
authors.affiliation: Case Comprehensive Cancer Center, Cleveland, Ohio.|Department of Epidemiology and Biostatistics, Case Western Reserve School of Medicine, Cleveland, Ohio.
authors.forename: Mark
authors.initials: M
authors.lastname: Schluchter
authors.affiliation: Case Comprehensive Cancer Center, Cleveland, Ohio.|Department of Epidemiology and Biostatistics, Case Western Reserve School of Medicine, Cleveland, Ohio.
authors.forename: Siran M
authors.initials: SM
authors.lastname: Koroukian
authors.affiliation: Department of Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Kathryn H
authors.initials: KH
authors.lastname: Schmitz
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Case Western Reserve School of Medicine, Cleveland, Ohio.|Case Comprehensive Cancer Center, Cleveland, Ohio.
authors.forename: Nathan A
authors.initials: NA
authors.lastname: Berger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D003131:Combined Modality Therapy; D015897:Comorbidity; D005260:Female; D015577:Geriatric Assessment; D006306:Health Surveys; D006801:Humans; D008137:Longitudinal Studies; D009026:Mortality; D009367:Neoplasm Staging; D011379:Prognosis; D012372:ROC Curve; D012307:Risk Factors; D012923:Social Class; D016896:Treatment Outcome
keywords: breast cancer; functional decline; low socioeconomic status; older women