The persistent impact of breast carcinoma on functional health status

Prospective evidence from the Nurses' Health Study

Authors

  • Yvonne L. Michael Sc.D.,

    1. School of Community Health, College of Urban and Public Affairs, Portland State University, Portland, Oregon
    Search for more papers by this author
  • Ichiro Kawachi M.D., Ph.D.,

    1. Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
    2. Department of Health and Social Behavior, Harvard School of Public Health, Boston, Massachusetts
    Search for more papers by this author
  • Lisa F. Berkman Ph.D.,

    1. Department of Health and Social Behavior, Harvard School of Public Health, Boston, Massachusetts
    2. Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
    Search for more papers by this author
  • Michelle D. Holmes M.D., D.P.H.,

    1. Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
    Search for more papers by this author
  • Graham A. Colditz M.D., D.P.H.

    Corresponding author
    1. Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
    2. Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
    • Channing Laboratory, 181 Longwood Avenue, Boston, MA 02115
    Search for more papers by this author
    • Fax: (617) 525-2008


Abstract

BACKGROUND

Although physical and emotional function after the diagnosis of breast carcinoma have been described in clinic populations, to the authors' knowledge no previous study has measured change from the preillness level of functional health status in community-dwelling women.

METHODS

The authors conducted a 4-year (1992–96) prospective study of functional recovery after breast carcinoma in a large sample of women, aged 54–73 years. They collected multidimensional measures of self-reported functional health status in 1992, before diagnosis of breast carcinoma, and again in 1996, to examine the risk of decline associated with incident breast carcinoma.

RESULTS

After adjustment for age, baseline functional health status, and multiple covariates, women who developed incident breast carcinoma were more likely to have experienced reduced physical function, role function, vitality, and social function and increased bodily pain compared with women who remained free of breast carcinoma. Risk of decline was attenuated with increasing time since diagnosis. Risk of decline in physical function was evident across all stages of breast carcinoma, even after adjustment for women undergoing treatment for persistent or recurrent disease. We found evidence that the risk of decline among breast carcinoma cases compared with healthy women was largest among those who were most socially isolated.

CONCLUSIONS

Breast carcinoma results in persistent declines in multiple dimensions of functional health status. These prospective data suggest that previous studies reporting no difference in physical function among breast carcinoma cases compared with disease free women underestimated the deleterious effect of the disease on function. Socially isolated women are an especially vulnerable group. Cancer 2000;89:2176–86. © 2000 American Cancer Society.

Ancillary