Overall health at diagnosis predicts the risk of complications within the first year after breast cancer diagnosis

Abstract

Purpose

Breast cancer patients with overall poor health are at a greater risk of both complications during treatment and mortality from competing causes. We sought to determine the association of pre-existing comorbidities on treatment-related complications and overall survival.

Methods

We identified women ages 40–90 years old from our institutional registry with stage I–II invasive breast cancer from 2005 to 2014. Recursive partitioning was used to stratify women based on pre-existing comorbidities as low, moderate, or high risk of treatment-associated complications. Cox proportional hazards model was constructed to estimate the association of risk with overall survival.

Results

2077 women were studied. Mean age was 60 (IQR 51–68). Over half (54%) had ≥ 1 comorbid condition, and 29% experienced at least one adverse medical event within 1 year of diagnosis. Risk categories included low (no comorbidities or hypertension), moderate (combinations of comorbidities excluding congestive heart failure), and high (congestive heart failure in isolation or in combination with other conditions). High-risk women had a lower 10-year OS compared to moderate- or low-risk women (89% vs 90% vs 96%, log-rank p < 0.001). After adjustment, being at moderate (HR 2.20, 95% CI 1.30–3.72, p = 0.003) or high risk (HR 5.07, 95% CI 1.66–15.52, p = 0.004) of adverse sequelae was associated with reduced OS compared to those at low risk of these adverse medical events.

Conclusions

Following breast cancer diagnosis, overall poor health was associated with a greater risk of mortality and complications within the first year of treatment, which was driven by a pre-existing diagnosis of congestive heart failure.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3

References

  1. 1.

    Greenlee RT, Murray T, Bolden S et al (2000) Cancer statistics, 2000. CA Cancer J Clin 50(1):7–33

    CAS  Article  Google Scholar 

  2. 2.

    Guralnik JM (1996) Assessing the impact of comorbidity in the older population. Ann Epidemiol 6(5):376–380

    CAS  Article  Google Scholar 

  3. 3.

    Aziz D, Gardner S, Pritchard K et al (2007) Selective application of axillary node dissection in elderly women with early breast cancer. Ann Surg Oncol 14(2):652–659. https://doi.org/10.1245/s10434-006-9092-y

    Article  PubMed  Google Scholar 

  4. 4.

    Yancik R, Ries LG, Yates JW (1989) Breast cancer in aging women. A population-based study of contrasts in stage, surgery, and survival. Cancer 63(5):976–981

    CAS  Article  Google Scholar 

  5. 5.

    Yancik R, Havlik RJ, Wesley MN et al (1996) Cancer and comorbidity in older patients: a descriptive profile. Ann Epidemiol 6(5):399–412

    CAS  Article  Google Scholar 

  6. 6.

    Satariano WA (1992) Comorbidity and functional status in older women with breast cancer: implications for screening, treatment, and prognosis. J Gerontol 47:24–31

    PubMed  Google Scholar 

  7. 7.

    Hutchins LF, Unger JM, Crowley JJ et al (1999) Underrepresentation of patients 65 years of age or older in cancer-treatment trials. N Engl J Med 341(27):2061–2067. https://doi.org/10.1056/NEJM199912303412706

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Lewis JH, Kilgore ML, Goldman DP et al (2003) Participation of patients 65 years of age or older in cancer clinical trials. J Clin Oncol 21(7):1383–1389. https://doi.org/10.1200/JCO.2003.08.010

    Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Barthelemy P, Heitz D, Mathelin C et al (2011) Adjuvant chemotherapy in elderly patients with early breast cancer. Impact of age and comprehensive geriatric assessment on tumor board proposals. Crit Rev Oncol Hematol 79(2):196–204. https://doi.org/10.1016/j.critrevonc.2010.06.005

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    El-Tamer MB, Ward BM, Schifftner T et al (2007) Morbidity and mortality following breast cancer surgery in women: national benchmarks for standards of care. Ann Surg 245(5):665–671. https://doi.org/10.1097/01.sla.0000245833.48399.9a

    Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Yood MU, Wells KE, Alford SH et al (2012) Cardiovascular outcomes in women with advanced breast cancer exposed to chemotherapy. Pharmacoepidemiol Drug Saf 21(8):818–827. https://doi.org/10.1002/pds.3239

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  12. 12.

    Hershman DL, Shao T (2009) Anthracycline cardiotoxicity after breast cancer treatment. Oncology (Williston Park) 23(3):227–234

    Google Scholar 

  13. 13.

    Land LH, Dalton SO, Jensen MB et al (2012) Influence of comorbidity on the effect of adjuvant treatment and age in patients with early-stage breast cancer. Br J Cancer 107(11):1901–1907. https://doi.org/10.1038/bjc.2012.472

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  14. 14.

    Onitilo AA, Kar P, Engel JM et al (2013) Long-term cardiac and vascular disease outcomes following adjuvant tamoxifen therapy: current understanding of impact on physiology and overall survival. Minerva Med 104(2):141–153

    CAS  PubMed  Google Scholar 

  15. 15.

    Harris EE (2008) Cardiac mortality and morbidity after breast cancer treatment. Cancer Control 15(2):120–129. https://doi.org/10.1177/107327480801500204

    Article  PubMed  Google Scholar 

  16. 16.

    Ording AG, Garne JP, Nystrom PM et al (2013) Comorbid diseases interact with breast cancer to affect mortality in the first year after diagnosis–a Danish nationwide matched cohort study. PLoS ONE 8(10):e76013. https://doi.org/10.1371/journal.pone.0076013

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Patnaik JL, Byers T, Diguiseppi C et al (2011) The influence of comorbidities on overall survival among older women diagnosed with breast cancer. J Natl Cancer Inst 103(14):1101–1111. https://doi.org/10.1093/jnci/djr188

    Article  PubMed  PubMed Central  Google Scholar 

  18. 18.

    Kimmick GG, Li X, Fleming ST et al (2018) Risk of cancer death by comorbidity severity and use of adjuvant chemotherapy among women with locoregional breast cancer. J Geriatr Oncol 9(3):214–220. https://doi.org/10.1016/j.jgo.2017.11.004

    Article  PubMed  Google Scholar 

  19. 19.

    Louwman WJ, Janssen-Heijnen ML, Houterman S et al (2005) Less extensive treatment and inferior prognosis for breast cancer patient with comorbidity: a population-based study. Eur J Cancer 41(5):779–785. https://doi.org/10.1016/j.ejca.2004.12.025

    CAS  Article  PubMed  Google Scholar 

  20. 20.

    Wu XC, Lund MJ, Kimmick GG et al (2012) Influence of race, insurance, socioeconomic status, and hospital type on receipt of guideline-concordant adjuvant systemic therapy for locoregional breast cancers. J Clin Oncol 30(2):142–150. https://doi.org/10.1200/JCO.2011.36.8399

    Article  PubMed  Google Scholar 

  21. 21.

    Extermann M (2000) Measuring comorbidity in older cancer patients. Eur J Cancer 36(4):453–471

    CAS  Article  Google Scholar 

  22. 22.

    Cronin-Fenton DP, Norgaard M, Jacobsen J et al (2007) Comorbidity and survival of Danish breast cancer patients from 1995 to 2005. Br J Cancer 96(9):1462–1468. https://doi.org/10.1038/sj.bjc.6603717

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  23. 23.

    Bouchardy C, Rapiti E, Blagojevic S et al (2007) Older female cancer patients: importance, causes, and consequences of undertreatment. J Clin Oncol 25(14):1858–1869. https://doi.org/10.1200/JCO.2006.10.4208

    Article  PubMed  Google Scholar 

  24. 24.

    Van Leeuwen BL, Rosenkranz KM, Feng LL et al (2011) The effect of under-treatment of breast cancer in women 80 years of age and older. Crit Rev Oncol Hematol 79(3):315–320. https://doi.org/10.1016/j.critrevonc.2010.05.010

    Article  PubMed  Google Scholar 

  25. 25.

    Oncology SoS (2016) Choosing Wisely: American Board of Internal Medicine https://www.choosingwisely.org/societies/society-of-surgical-oncology/. Accessed 8 June 2019

  26. 26.

    Rosenkranz KM, Bedrosian I, Feng L et al (2006) Breast cancer in the very elderly: treatment patterns and complications in a tertiary cancer center. Am J Surg 192(4):541–544. https://doi.org/10.1016/j.amjsurg.2006.06.019

    Article  PubMed  Google Scholar 

  27. 27.

    Mogal HD, Clark C, Dodson R et al (2017) Outcomes after mastectomy and lumpectomy in elderly patients with early-stage breast cancer. Ann Surg Oncol 24(1):100–107. https://doi.org/10.1245/s10434-016-5582-8

    Article  PubMed  Google Scholar 

  28. 28.

    Hughes KS, Schnaper LA, Bellon JR et al (2013) Lumpectomy plus tamoxifen with or without irradiation in women age 70 years or older with early breast cancer: long-term follow-up of CALGB 9343. J Clin Oncol 31(19):2382–2387. https://doi.org/10.1200/JCO.2012.45.2615

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  29. 29.

    Hughes KS, Schnaper LA, Berry D et al (2004) Lumpectomy plus tamoxifen with or without irradiation in women 70 years of age or older with early breast cancer. N Engl J Med 351(10):971–977. https://doi.org/10.1056/NEJMoa040587

    CAS  Article  PubMed  Google Scholar 

  30. 30.

    Short ME, Goetzel RZ, Pei X et al (2009) How accurate are self-reports? Analysis of self-reported health care utilization and absence when compared with administrative data. J Occup Environ Med 51(7):786–796. https://doi.org/10.1097/JOM.0b013e3181a86671

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Rachel A. Greenup.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 16 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Ong, C.T., Ren, Y., Thomas, S.M. et al. Overall health at diagnosis predicts the risk of complications within the first year after breast cancer diagnosis. Breast Cancer Res Treat 182, 439–449 (2020). https://doi.org/10.1007/s10549-020-05700-8

Download citation

Keywords

  • Breast cancer
  • Comorbidities
  • Treatment complications
  • Recursive partitioning