Incident comorbidities and all-cause mortality among 5-year survivors of Stage I and II breast cancer diagnosed at age 65 or older: a prospective-matched cohort study
- 402 Downloads
Five-year breast cancer survivors, diagnosed after 65 years of age, may develop more incident comorbidities than similar populations free of cancer. We investigated whether older breast cancer survivors have a similar comorbidity burden 6–15 years after cancer diagnosis to matched women free of breast cancer at start of follow-up and whether incident comorbidities are associated with all-cause mortality. In this prospective cohort study, 1,361 older 5-year early-stage breast cancer survivors diagnosed between 1990 and 1994 and 1,361 age- and health system-matched women were followed for 10 years. Adjudicated medical record review captured prevalent and incident comorbidities during follow-up or until death as collected from the National Death Index. Older 5-year breast cancer survivors did not acquire incident comorbidities more often than matched women free of breast cancer in the subsequent 10 years [hazard ratio (HR) 1.0, 95 % confidence interval (95 % CI) 0.93, 1.1]. Adjusted for cohort membership, women with incident comorbidities had a higher mortality rate than those without incident comorbidities (HR 4.8, 95 % CI 4.1, 5.6). A breast cancer history continued to be a hazard for mortality 6–15 years after diagnosis (HR 1.3, 95 % CI 1.1, 1.4). We found that older breast cancer survivors who developed comorbidities had an increased all-cause mortality rate even after adjusting for age and prevalent comorbidity burden. Additionally, survivors acquire comorbidities at a rate similar to older women free of breast cancer. These results highlight the association between comorbidity burden and long-term mortality risk among older breast cancer survivors and their need for appropriate oncology and primary care follow-up.
KeywordsBreast cancer Survivorship Comorbidity Geriatrics Managed care Mortality
American Joint Committee on Cancer
Breast Cancer Treatment Effectiveness in Older Women cohort study
Charlson Comorbidity Index
Modified Charlson Comorbidity Index
Surveillance, epidemiology, and end results
This study was funded by Public Health Service Grant R01CA093772 from the National Cancer Institute, National Institutes of Health, Department of Health and Human Services (PI: RA Silliman). The funding sponsors played no part in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. Sponsors had no access to the data and did not perform any of the study analysis.
Conflict of interest
The authors declare that they have no conflict of interest.
This study complies with the current laws of the United States of America. This study was reviewed and approved by the Institutional Review Boards of each participating institution and at the Boston University Medical Center.
- 2.American Cancer Society (2011) Breast cancer facts & figures 2011–2012. American Cancer Society Inc., AtlantaGoogle Scholar
- 4.Van De Water W, Markopoulos C, Van De Velde CJ, Seynaeve C, Hasenburg A, Rea D, Putter H, Nortier JW, De Craen AJ, Hille ET, Bastiaannet E, Hadji P, Westendorp RG, Liefers GJ, Jones SE (2012) Association between age at diagnosis and disease-specific mortality among postmenopausal women with hormone receptor-positive breast cancer. J Am Med Assoc 307(6):590–597. doi: 10.1001/Jama.2012.84 Google Scholar
- 11.Hanchate AD, Clough-Gorr KM, Ash AS, Thwin SS, Silliman RA (2010) Longitudinal patterns in survival, comorbidity, healthcare utilization and quality of care among older women following breast cancer diagnosis. J Gen Intern Med 25(10):1045–1050. doi: 10.1007/S11606-010-1407-9 PubMedCentralPubMedCrossRefGoogle Scholar
- 14.Wagner EH, Greene SM, Hart G, Field TS, Fletcher S, Geiger AM, Herrinton LJ, Hornbrook MC, Johnson CC, Mouchawar J, Rolnick SJ, Stevens VJ, Taplin SH, Tolsma D, Vogt TM (2005) Building a research consortium of large health systems: the cancer research network. J Natl Cancer Inst Monogr 35:3–11. doi: 10.1093/Jncimonographs/Lgi032 PubMedCrossRefGoogle Scholar
- 15.Edge S, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A (2010) AJCC cancer staging manual, 7th edn. Springer, New YorkGoogle Scholar
- 17.Thwin SS, Clough-Gorr KM, Mccarty MC, Lash TL, Alford SH, Buist DS, Enger SM, Field TS, Frost F, Wei F, Silliman RA (2007) Automated inter-rater reliability assessment and electronic data collection in a multi-center breast cancer study. BMC Med Res Methodol 7:23. doi: 10.1186/1471-2288-7-23 PubMedCentralPubMedCrossRefGoogle Scholar
- 20.Lash TL, Fox MP, Thwin SS, Geiger AM, Buist DS, Wei F, Field TS, Yood MU, Frost FJ, Quinn VP, Prout MN, Silliman RA (2007) Using probabilistic corrections to account for abstractor agreement in medical record reviews. Am J Epidemiol 165(12):1454–1461. doi: 10.1093/Aje/Kwm034 PubMedCrossRefGoogle Scholar
- 21.Adamo MB, Ruhl JL, Dickie LA (Ed) 2011 seer program coding and staging manual. National Cancer Institute, NIH publication number 11-5581, Bethesda, MDGoogle Scholar
- 26.Houterman S, Janssen-Heijnen MLG, Verheij CDGW, Louwman WJ, Vreugdenhil G, Van Der Sangen MJC, Coebergh JWW (2004) Comorbidity has negligible impact on treatment and complications but influences survival in breast cancer patients. Br J Cancer 90(12):2332–2337. doi: 10.1038/Sj.Bjc.6601844 PubMedCentralPubMedGoogle Scholar
- 29.Sarfati D (2012) Review of methods used to measure comorbidity in cancer populations: no gold standard exists. J Clin Epidemiol. doi: 10.1016/J.Jclinepi.2012.02.017
- 30.Quan H, Li B, Couris CM, Fushimi K, Graham P, Hider P, Januel JM, Sundararajan V (2011) Updating and validating the Charlson Comorbidity Index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol 173(6):676–682. doi: 10.1093/Aje/Kwq433 PubMedCrossRefGoogle Scholar
- 32.Chavez-Macgregor M, Zhao H, Kroll M, Fang S, Zhang N, Hortobagyi GN, Buchholz TA, Shih YC, Giordano SH (2011) Risk factors and incidence of thromboembolic events (TEEs) in older men and women with breast cancer. Ann Oncol 22(11):2394–2402. doi: 10.1093/Annonc/Mdq777 PubMedCentralPubMedCrossRefGoogle Scholar
- 35.Harlan LC, Klabunde CN, Ambs AH, Gibson T, Bernstein L, Mctiernan A, Meeske K, Baumgartner KB, Ballard-Barbash R (2009) Comorbidities, therapy, and newly diagnosed conditions for women with early stage breast cancer. J Cancer Surviv 3(2):89–98. doi: 10.1007/S11764-009-0084-3 PubMedCentralPubMedCrossRefGoogle Scholar