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

• Type of Material: Article
• Authors: Jennifer H. Jordan, Wake Forest School of Medicine; Soe Soe Thwin, Boston University; Timothy L Lash, Emory University; Diana S.M. Buist, Group Health Research Institute; Terry S. Field, Meyers Primary Care Institute; Reina Haque, Kaiser Permanente Southern California; Pamala A. Pawloski, HealthPartners Institute for Education and Research; Hans V. Petersen, Lovelace Respiratory Research Institute; Marianne N. Prout, Boston University; Virginia P. Quinn, Kaiser Permanente Southern California; Marianne Ulcickas Yood, Boston University; Rebecca A. Silliman, Boston University; Ann M. Geiger, National Cancer Institute
• Language: English
• Date: 2014-07-01
• Publisher: SPRINGER
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2014 Springer Science+Business Media.
• Final Published Version (URL): http://dx.doi.org/10.1007/s10549-014-3021-8
• Title of Journal or Parent Work: Breast Cancer Research and Treatment
• Volume: 146
• Issue: 2
• Start Page: 401
• End Page: 409
• Grant/Funding Information: 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).
• Keywords: IMPACT; Science & Technology; POSTMENOPAUSAL WOMEN; Managed care; Oncology; Breast cancer; CARE; Geriatrics; Comorbidity; RISK; DISEASE; Mortality; THERAPY; Life Sciences & Biomedicine; Survivorship
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Oncology

Abstract

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.