Health profiles of younger and older breast cancer survivors

Authors

  • Charles J. Stava,

    1. Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • Adriana Lopez MS,

    1. Department of Biostatistics and Applied Mathematics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • Rena Vassilopoulou-Sellin MD

    Corresponding author
    1. Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
    • Department of Endocrine Neoplasia and Hormonal Disorders, Unit 435, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston TX 77030
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    • Fax: (713) 794-4065


Abstract

BACKGROUND.

Over the past several decades, the incidence of prolonged survival after a diagnosis of cancer has increased; however, little is known regarding the long-term health profiles of cancer survivors in general and of breast cancer survivors in particular. To obtain more information concerning the consequences of surviving breast cancer, the authors conducted a large-scale health survey of patients who had been treated for the disease at their institution.

METHODS.

A descriptive analysis of information was provided by cancer survivors. Of the breast cancer survivors who were studied, 695 women were age <45 years, 580 women were between ages 46 years and 54 years, and 655 women were age > 55 years at the time of diagnosis. Their medical and psychosocial responses were analyzed and compared with those of age-matched responders in a national survey.

RESULTS.

Younger breast cancer survivors received chemotherapy more often than older survivors and were more likely to report memory loss and that cancer had affected their overall health adversely. Several other differences in physiologic and psychosocial characteristics, such as interpersonal relationships, also emerged.

CONCLUSIONS.

Physiologic and psychosocial differences distinguished younger breast cancer survivors from older breast cancer survivors. The findings of this study suggested that a systematic analysis of cancer survivors is needed to understand their unique health profiles and needs. Cancer 2006. © 2006 American Cancer Society.

Thanks to progress in the detection and treatment of cancer, cancer survivors currently make up 3.5% of the American population; 10.1 million individuals in the US. had survived cancer as of 2002.1 In addition, 64% of cancer survivors are expected to live for 5 years after diagnosis.2

Women with a history of breast cancer comprise the largest group of cancer survivors. Currently, 1 in 7 women are diagnosed with breast cancer; however, the lifetime risk of dying of the disease is only 2.3%.3, 4 In 2005 alone, 211,240 women were newly diagnosed with breast cancer in America, suggesting that there is an increasing number of breast cancer survivors.4 Indeed, the Institute of Medicine and the National Research Council recently emphasized the need for survivorship research; specifically calling for descriptive studies to define the late and lasting medical and psychosocial sequelae of cancer and cancer treatments.5

At The University of Texas M. D. Anderson Cancer Center (M. D. Anderson), we have initiated a survivorship program, called Life After Cancer Care (LACC), through which we can analyze information that is provided systematically by more than 10,000 cancer survivors; we have published information on hearing loss,6 cataracts,7 and the influence of ethnicity8 and on specific diseases, like thyroid cancer.9

In the current report, we are focusing on breast cancer, particularly the impact of age at diagnosis on breast cancer survivorship, because age affects the cancer experience in general and, for breast cancer specifically, on cancer treatments, which independently may affect long-term health. In addition, we compare health profiles of breast cancer survivors with the profiles of individuals who participated in a national study to determine whether and how the groups differ. Because the perimenopausal transition often is difficult to pinpoint, we analyzed information provided by women age <45 years at the time of diagnosis (clearly premenopausal), women ages 46 to 54 years (perimenopausal), and women age >55 years (clearly postmenopausal).

MATERIALS AND METHODS

A survey was generated to capture cancer survivors' self-reported information regarding their long-term health profiles that may have resulted from cancer or its treatment, including medical, physiologic, and psychosocial late effects; the methodology and characteristics of this population has been described previously.10 Briefly, the responders were former patients who remained alive >5 years after diagnosis and who no longer required treatment at M.D. Anderson; an intake assessment tool used at the M.D. Anderson clinic provided the blueprint for the survey. In addition to the general question, “do you believe that cancer affected your overall health,” we asked women about specific health conditions that may have been associated with their cancer. We also asked whether having cancer had affected their family and/or intimate relationships. We carried out a descriptive analysis of the information derived from these surveys. The Institutional Review Board at M.D. Anderson approved this study with its survey component.

Data collected from the survey were stored in a computer (Oracle Enterprise Edition, Version 8.1.5; Oracle, Redwood Shores, CA), which is maintained and updated on a regular basis by M.D. Anderson's information technology team and by the LACC team. Statistical analyses were performed in 2 parts. The groundwork analysis was conducted with Statistica for Windows (version 6.1; StatSoft, Tulsa OK). Frequently, distributions and histograms were used to describe the distribution of the responses fully. Descriptive statistics, including percentages, means, standard deviations, and ranges, were used to express the information gleaned from the survey.

The calculation of the statistical significance of the data analyzed was performed by M.D. Anderson's Department of Biostatistics and Applied Mathematics. For the purpose of this study, P values < .01 were considered significant. Demographic characteristics, the duration of survivorship, and patient age at the time of the study survey were summarized for the 3 age groups of breast cancer survivors. Univariate comparisons of the categorical variables were performed by using chi-square or Fisher exact tests. A Shapiro–Wilks test for normality was performed on continuous variables and, the basis of its results, either a 2-sample t test or a continuous Kruskal–Wallis or Wilcoxon rank-sum test, was used to compare these variables in younger patients with breast cancer with the same variables in older patients.

Similar analyses were used to compare categorical and continuous variables in breast cancer patients who had received different therapies. Finally, the proportions of patients who reported health problems related to their cancer were determined for breast cancer patients both overall and by type of treatment received. These proportions were then compared according to demographic variables by using chi-square or Fisher exact tests, the 2-sample t test, or a continuous Kruskal–Wallis or Wilcoxon rank-sum test. These analyses were performed using SAS software (version 9.1; SAS Institute, Cary, NC).

RESULTS

Population

After 3 consecutive annual mailings between 2000 and 2003, 9047 surveys had been completed and returned. Excluding 387 surveys from patients who were diagnosed before age 18 years and 101 surveys with incomplete data, we had information from 8559 cancer survivors, including 1930 women (22.5%) of who had survived breast cancer. Among the latter group, 695 women were age <45 years, 580 women were between ages 46 years and 54 years, and 655 women were age >55 years at the time of their diagnosis. We compared young breast cancer survivors (YBC) versus middle-aged breast survivors (MBC) and older breast cancer survivors (OBC). In addition, we compared the breast survivors with age-matched and gender-matched individuals in the general population.11

Participant Characteristics

The mean age ± standard deviation at diagnosis was 38.9 ± 5.0 years for the YBC group, 49.7 ± 2.5 years for the MBC group, and 62.4 ± 6.1 years for the OBC group (P < .0001) (Table 1). Most survivors were diagnosed between ages 36 years and 45 years in the young groups and between 55 to 65 years for the older groups. Figure 1 shows the age distribution at diagnosis. The mean age ± standard deviation at the time of the survey was 55.6 ± 10.3 years for the YBC group, 64.3 ± 8.3 years for the MBC group, and 74.1 ± 7.7 years for the OBC group. We observed that the differences in age at the time of the survey were significant (P < .0001). Figure 2 shows the interval between diagnosis and survey completion; many responses were from women >10 years after diagnosis, providing information on very long-term sequelae.

Figure 1.

The mean age at diagnosis illustrated for women who survived breast cancer. YBC indicates young cancer survivors; MBC, middle-aged cancer survivors; OBC, older breast cancer survivors.

Figure 2.

Distribution of the interval between diagnosis and survey is illustrated. Breast ca indicates breast cancer.

Table 1. Mean Age at Diagnosis and Survey
VariableYBC (Age ≤45 years)MBC (Ages 46–54 years)OBC (Age >55 years)
  1. YBC indicates young breast cancer survivors; MBC, middle-aged breast cancer survivors; OBC, older breast cancer survivors.

No. of survivors695580655
Mean age at diagnosis, y38.9 ± 5.049.7 ± 2.562.4 ± 6.1
Mean age at survey, y55.6 ± 10.364.3 ± 8.374.1 ± 7.7
Years since diagnosis16.8 ± 9.414.5 ± 8.111.7 ± 6.4

Health Care

Women in the YBC group were under the care of an obstetrician/gynecologist more often than women in the OBC group (Table 2), and women in the MBC group reported seeing an oncologist and a primary care physician more often than women in the other groups (43.4% vs. 23.3%) than the other groups. However, all groups reported seeing an oncologist more often than any other health care provider. Among the YBC responders, 2.1% reported not seeing a physician compared to with 1.2% of MBC responders and 1.5% of OBC responders. Age was identified as a significant factor (P < .01) for the use of internists and obstetrician/gynecologists but not for the other health care providers.

Table 2. Health Care Use by Cancer Survivor Age*
VariableNo. of patients (%)
YBC (Age ≤ 45 years)MBC (Ages 46–54 years)OBC (Age > 55 years)
  • YBC indicates young breast cancer survivors; MBC, middle-aged breast cancer survivors; OBC, older breast cancer survivors; OB/GYN, obstetrician/gynecologist.

  • *

    Note that some participants saw >1 health care provider.

  • P ≤ .01 (YBC vs. MBC; chi-square test).

  • P ≤ .01 (YBC vs. OBC; chi-square test).

  • §

    P ≤ .01 (MBC vs. OBC; chi-square test).

No. of patients with health care provider695580655
Family physician264 (38.0)209 (36.1)262 (40.0)
Internist148 (21.3),160 (27.6)189 (28.9)
OB/GYN256 (36.8)186 (32.1)§136 (20.8)
Oncologist283 (40.7)252 (43.4)280 (42.7)
Primary care physician139 (20.0)135 (23.3)125 (19.1)
Other physician110 (15.8)100 (17.2)131 (20.0)
No physician14 (2.1)7 (1.2)10 (1.5)

Treatment

Table 3 shows the breakdown by 2 treatment types: with and without chemotherapy. Both treatments likely include the use of hormone therapy. (It is possible that some responders who took hormone therapy may have checked chemotherapy on the survey).

Table 3. Cancer Treatment*
VariableNo. of patients (%)
YBC (Age ≤ 45 years)MBC (Ages 46–54 years)OBC (Age > 55 years)
  • YBC indicates young breast cancer survivors; MBC, middle-aged breast cancer survivors; OBC, older breast cancer survivors.

  • *

    Note that some participants received >1 type of treatment.

No. of patients who received treatment695580655
Treatment including chemotherapy412 (59.3)296 (51.3)249 (38.0)
Treatment without chemotherapy283 (40.7)284 (48.9)406 (61.9)

More responders in the YBC group reported taking chemotherapy as part of their treatment regimen (59.3%) than responders in the 2 other age groups (51.3% for the MBC group; 38.0% for the OBC group). Nearly 62% of the older breast cancer survivors did not receive chemotherapy as treatment. Age was identified as a significant element (P < .0001) in the receipt of chemotherapy as treatment for breast cancer.

Interpersonal Relationships

The cancer survivors were given an opportunity to comment on how cancer had affected their interpersonal relationships (Table 4); most indicated that cancer did affect their family and intimate relationships. The left side of Table 4 reflects the overall group, in which the younger survivors were more likely to report that their family relationships had improved (57.3%) and that their intimate relationships were harmed (33.1%).

Table 4. The Effect of Cancer on Participants' Interpersonal Relationships*
VariableNo. of patients (%)
Overall groupHealth-affected group
YBC (Age ≤45 years)MBC (Ages 46–54 years)OBC (Age >55 years)YBC (Age ≤45 years)MBC (Ages 46–54 years)OBC (Age >55 years)
  • YBC indicates young breast cancer survivors; MBC, middle-aged breast cancer survivors; OBC, older breast cancer survivors.

  • *

    Note that some participants did not respond. Percentages are based on those who responded.

  • P ≤ .01 (YBC vs. OBC; chi-square test).

  • P ≤ .01 (MBC vs. OBC; chi-square test).

  • §

    P ≤ .01 (YBC vs. MBC; chi-square test).

No. of patients695580655297209159
Improved family relationships384 (57.3)298 (56.6)229 (41.3)171 (59.2)116 (59.7)66 (46.2)
Hurt family relationships98 (14.4)§39 (7.0)38 (6.3)66 (22.6)31 (16.1)27 (18.6)
Improved intimate relationships163 (25.2)119 (23.4)84 (15.4)67 (23.6)43 (23.1)21 (16.2)
Hurt intimate relationships219 (33.1)140 (26.7)95 (17.4)141 (49.1)79 (42.2)53 (38.4)

The right side of Table 4 outlines the responses of women who reported that that their cancer had affected their overall health. The YBC group reported that their intimate relationships were harmed more frequently than the other groups (49.1% vs. 42.2% for the MBC group and 38.4% for the OBC group), but the differences were not significant. Age was a significant factor overall (P < .0001) for interpersonal relationships.

Long-Term Health Problems

Table 5 outlines the physiologic health problems reported by the different age groups. Women in the YBC group reported loss of memory (14.2%), migraine headaches (5.0%), and psychological problems (5.2%) more frequently than the women in the OBC group (9.8%, 2.9%, and 2.1%, respectively); whereas women in the OBC group reported more arthritis/osteoarthritis, cataracts, diabetes, strokes, and hearing impairment (the latter pattern may reflect age rather than the antecedent malignancy).

Table 5. Long-Term Health Problems of Cancer Survivors: Overall Group*
VariableNo. of patients (%)Overall P
YBC (Age ≤ 45 years)MBC (Ages 46–54 years)OBC (Age > 55 years)
  • YBC indicates young breast cancer survivors; MBC, middle-aged breast cancer survivors; OBC, older breast cancer survivors.

  • *

    Note that most patients reported >1 health effect.

  • Chi-square test.

  • Fisher exact test.

No. of patients695580655 
Abdominal pain39 (5.6)36 (6.2)37 (5.6).8833
Arthritis/osteoarthritis231 (33.2)226 (39.0)275 (42.0).0034
Bleeding problems20 (2.9)14 (2.4)11 (1.7).3411
Cataracts55 (7.9)93 (16.0)180 (27.5)<.0001
Circulation problems65 (9.4)49 (8.5)68 (10.4).5081
Diabetes31 (4.5)41 (7.1)64 (9.8).0007
Dizziness34 (4.9)42 (7.2)59 (9.0).0119
Frequent infections49 (7.1)38 (6.6)29 (4.4).1035
Hearing impairment39 (5.6)56 (9.7)96 (14.6)<.0001
Heart problems83 (11.9)77 (13.3)102 (15.6).1458
Kidney problems35 (5.0)30 (5.2)48 (7.3).1412
Liver problems13 (1.9)8 (1.4)5 (0.7).2105
Loss of memory99 (14.2)68 (11.7)64 (9.8).0397
Lung problems47 (6.8)25 (4.3)46 (7.0).0935
Migraine headaches35 (5.0)26 (4.5)19 (2.9).1283
Psychological problems36 (5.2)37 (6.4)14 (2.1).0009
Seizures1 (0.1)04 (0.6).0238
Skin problems29 (4.2)28 (4.8)32 (4.9).7876
Strokes9 (1.3)12 (2.1)26 (4.0).0049
Thyroid problems62 (8.9)67 (11.6)65 (9.9).2955
Other cancers63 (9.1)32 (5.5)75 (11.5).0011

Table 6 outlines reported health problems stratified by treatment modality. Older survivors in both treatment groups reported more health problems than younger responders in the same treatment category, which, again may reflect on age rather than malignancy. Younger survivors who received chemotherapy reported significantly more circulation problems (12.4%) and loss of memory (20.9%) than their age-matched counterparts who did not receive chemotherapy (5.0% and 4.6%, respectively). The receipt of chemotherapy appeared to increase the problem of memory loss among younger survivors.

Table 6. Long-Term Health Problems of Cancer Survivors: Treatment Groups*
VariableNo. of patients (%)
Treatment with chemotherapyTreatment without chemotherapy
YBC (Age ≤45 years)MBC (Ages 46–54 years)OBC (Age >55 years)Overall PYBC (Age ≤45 years)MBC (Ages 46–54 years)OBC (Age >55 years)Overall P
  • YBC indicates young breast cancer survivors; MBC, middle-aged breast cancer survivors; OBC, older breast cancer survivors.

  • *

    Note that most patients reported >1 health effect.

  • Chi-square test.

  • Fisher exact test.

No. of patients412296249 283284406 
Abdominal pain24 (5.8)17 (5.7)21 (8.4).345515 (5.3)19 (6.7)16 (3.9).2708
Arthritis/osteoarthritis134 (32.5)113 (38.2)110 (44.2).010397 (34.3)113 (39.8)165 (40.6).2106
Bleeding problems12 (2.9)8 (2.7)7 (2.8).98628 (2.8)6 (2.1)4 (1.0).1952
Cataracts14 (3.4)32 (10.8)58 (23.3)<.000141 (14.5)61 (21.5)122 (30.1)<.0001
Circulation problems51 (12.4)24 (8.1)30 (12.1).164014 (5.0)25 (8.8)38 (9.4).0867
Diabetes15 (3.6)20 (6.8)22 (8.8).018616 (5.7)21 (7.4)42 (10.3).0742
Dizziness22 (5.3)20 (6.8)27 (10.8).027912 (4.2)22 (7.8)32 (7.9).1296
Frequent infections33 (8.0)21 (7.1)20 (8.0).884916 (5.7)17 (6.0)9 (2.2).0238
Hearing impairment19 (4.6)29 (9.8)29 (11.7).002320 (7.1)27 (9.5)67 (16.5).0003
Heart problems47 (11.4)30 (10.1)39 (15.7).121036 (12.7)47 (16.6)63 (15.5).4122
Kidney problems26 (6.3)15 (5.1)17 (6.8).66539 (3.2)15 (5.3)31 (7.6).0426
Liver problems9 (2.2)5 (1.7)3 (1.2).64654 (1.4)3 (1.1)2 (0.5).3695
Loss of memory86 (20.9)52 (17.6)31 (12.5).022613 (4.6)16 (5.6)33 (8.1).1453
Lung problems26 (6.3)10 (3.4)24 (9.6).011021 (7.4)15 (5.3)22 (5.4).4672
Migraine Headaches25 (6.1)16 (5.4)11 (4.4).662610 (3.5)10 (3.5)8 (2.0).3584
Psychological problems25 (6.1)21 (7.1)6 (2.4).041911 (3.9)16 (5.6)8 (2.0).0376
Seizures002 (0.8).06751 (0.4)02 (0.5).6342
Skin problems19 (4.6)18 (6.1)15 (6.0).621210 (3.5)10 (3.5)17 (4.2).8686
Strokes4 (1.0)9 (3.0)9 (3.6).05295 (1.8)3 (1.1)17 (4.2).0227
Thyroid problems30 (7.3)38 (12.8)25 (10.0).047332 (11.3)29 (10.2)40 (9.9).8220
Other cancers39 (9.5)21 (7.1)41 (16.5).001224 (8.5)11 (3.9)34 (8.4).0427

The same information is presented in Table 7 for the subgroup of women who indicated that cancer had affected their health. Survivors of all age groups who received chemotherapy reported significantly more bleeding problems (4.4% of the YBC group, 4.3% of the MBC group, and 7.3% of the OBC group) than survivors who did not receive chemotherapy (1.4%, 1.5%, and 0%, respectively). One of the most reported health problems among survivors who received chemotherapy was memory loss (29.8% of the YBC group, 27.7% of the MBC group, and 20.8% of the OBC group), which they reported nearly twice as often as survivors who did not receive chemotherapy (12.5%, 14.7%, and 14.3%, respectively). Thus, loss of memory was a prominent complaint of YBC survivors (14.2%): It was even more prominent if they had received chemotherapy (20.9%), and it was especially prominent especially if women believed that cancer had affected their overall health (29.8%).

Table 7. Long-Term Health Problems of Cancer Survivors: Health-Affected Group by Treatment*
VariableNo. of patients (%)
Treatment with chemotherapyTreatment without chemotherapy
YBC (Age ≤45 years)MBC (Ages 46–54 years)OBC (Age >55 years)Overall PYBC (Age ≤45 years)MBC (Ages 46–54 years)OBC (Age >55 years)Overall P
  • YBC indicates young breast cancer survivors; MBC, middle-aged breast cancer survivors; OBC, older breast cancer survivors.

  • *

    Note that most patients reported >1 health effect.

  • Chi-square test.

  • Fisher exact test.

No. of patients22514196 726863 
Abdominal pain23 (10.2)14 (9.9)15 (15.6).31295 (6.9)10 (14.7)7 (11.1).3350
Arthritis/osteoarthritis87 (38.7)74 (52.5)58 (60.4).000635 (48.6)43 (63.2)39 (61.9).1537
Bleeding problems10 (4.4)6 (4.3)7 (7.3).50221 (1.4)1 (1.5)01.0000
Cataracts6 (2.7)18 (12.8)25 (26.0)<.00018 (11.1)16 (23.5)24 (38.1).0011
Circulation problems44 (19.6)17 (12.1)18 (18.8).15954 (5.6)13 (19.1)13 (20.6).0224
Diabetes9 (4.0)13 (9.2)11 (11.5).03086 (8.3)6 (8.8)8 (12.7).6562
Dizziness18 (8.0)17 (12.1)16 (16.7).06855 (6.9)11 (16.2)12 (19.1).0989
Frequent infections27 (12.0)17 (12.1)17 (17.7).34209 (12.5)10 (14.7)3 (4.8).1600
Hearing impairment13 (5.8)17 (12.1)21 (21.9)<.00019 (12.5)12 (17.7)14 (22.2).3267
Heart problems35 (15.6)16 (11.4)21 (21.9).090217 (23.6)15 (22.1)13 (20.6).9170
Kidney problems16 (7.1)13 (9.2)10 (10.4).57403 (4.2)6 (8.8)12 (19.1).0159
Liver problems7 (3.1)5 (3.6)1 (1.0).57481 (1.4)1 (1.5)2 (3.2).6901
Loss of memory67 (29.8)39 (27.7)20 (20.8).25559 (12.5)10 (14.7)9 (14.3).9223
Lung problems20 (8.9)7 (5.0)19 (19.8).00077 (9.7)8 (11.8)8 (12.7).8541
Migraine Headaches23 (10.2)7 (5.0)7 (7.3).18853 (4.2)5 (7.4)3 (4.8).7367
Psychological problems21 (9.3)15 (10.6)4 (4.2).19429 (12.5)10 (14.7)3 (4.8).1600
Seizures0001 (1.4)01 (1.6).7619
Skin problems14 (6.2)12 (8.5)8 (8.3).65896 (8.3)7 (10.3)7 (11.1).8545
Strokes4 (1.8)5 (3.6)4 (4.2).32412 (2.8)1 (1.5)6 (9.5).1001
Thyroid problems15 (6.7)19 (13.5)15 (15.6).024012 (16.7)11 (16.2)8 (12.7).7891
Other cancers26 (11.6)15 (10.6)25 (26.0).00109 (12.5)6 (8.8)11 (17.5).3339

Comparison with the National Health Interview Survey

We compared breast cancer survivors' self-reported health conditions with age-matched responses derived from the National Health Interview Survey (NHIS) (Table 8) (data from the U.S. Department of Health and Human Services, 200211). Seven health conditions reported in the NHIS were comparable to items in our survey: arthritis, diabetes, hearing loss, kidney problems, liver problems, heart disease, and migraine headaches (The NHIS likely included some cancer survivors and both genders.) Breast cancer survivors age < 45 years at the time of the survey reported more arthritis (14.5%) and heart disease (16.8%) than age-matched NHIS responders (7.8% and 4.0%, respectively). Breast cancer survivors ages 45 years to 64 years indicated more heart disease (16.3%) than NHIS responders (12.7%), but more NHIS responders reported hearing loss (17.5% vs. 5.7%). Breast cancer survivors age > 65 years reported more heart disease (34.4%) than NHIS responders (30.4%) but less arthritis, hearing impairment, and diabetes. It is noteworthy that heart disease was reported more frequently among breast cancer survivors in all age groups.

Table 8. The Health Status of Breast Cancer Survivors versus the Health Status of National Health Interview Survey Participants*
VariablePercentage of patients
Age ≤44 yearsAges 45–64 yearsAge ≥65 years
Breast cancer survivors (n = 83)NHIS participants (n = 108,114)Breast cancer survivors (n = 846)NHIS participants (n = 64,650)Breast cancer survivors (n = 971)NHIS participants (n = 33,061)
  • NHIS indicates National Health Interview Survey.

  • *

    Based on data from the U.S. Department of Health and Human Services, 2002.11

  • At the time of the survey.

Arthritis14.57.834.528.842.947.5
Diabetes mellitus2.41.95.39.59.115.9
Hearing loss4.86.75.717.514.137.1
Heart disease16.84.016.312.734.430.4
Kidney problems4.80.65.11.56.73.1
Liver problems2.40.81.41.91.01.1
Migraine headaches4.817.65.115.33.26.6

DISCUSSION

In the current report, we explored the effects of cancer and its treatment on a cohort of breast cancer survivors and compared them with age-matched representatives of a general population survey. This descriptive analysis has several limitations, including the possibility of reporting bias; nevertheless, this same potential issue is shared in common with responses from the NHIS population. Our findings, we believe, complement and extend the excellent overview regarding breast cancer survivorship presented in the Institute of Medicine Report.5

A number of distinctions emerged among the different age groups. Among the young cancer survivors, YBC women received chemotherapy more often than MBC and OBC women; they also reported more neuropsychological problems, such as migraine headaches, and they reported psychological problems and especially loss of memory. Overall, the younger survivors reported that their family relationships improved as result of their cancer, but they were more likely to report that cancer had affected their health. The older survivors reported more health problems, but the latter problems may have been attributed to age rather than antecedent malignancy.

Both the age of the patient and the era of diagnosis influence the treatments for malignancies,12, 13 and such differences are very likely, in turn, to influence the long-term effects of cancer. Information generally is sparse regarding long-term survivors of adult cancers,10 although a number of studies have begun to address the long-term health of breast cancer survivors. For the most part, like most oncology literature, research on breast cancer survivorship focuses on treatment options, their side effects, and the impact on survival from the cancer rather than the impact of these treatments on the long-term health of survivors. Loescher et al. suggested that cancer treatments may affect multiple body systems months or years after treatment and that surviving cancer itself can have adverse psychosocial implications14, 15 In addition, most studies examine the early years after cancer diagnosis and do not capture the long-term health consequences of cancer therapies.16 Some studies have demonstrated that younger women with breast cancer (i.e., those diagnosed before age 50 years) generally have good quality of life and higher levels of functioning.17–19 Premenopausal women are especially vulnerable to the physical and psychosocial late effects of their treatment because of its generally more aggressive nature and their relative youth. Our study shows that survivors of breast cancer in general enjoy either maintained or strengthened interpersonal relationships after their cancer diagnosis. This finding is in agreement with the findings from other studies.20–22

We observed that breast cancer survivors reported many musculoskeletal problems. Premenopausal women may develop premature ovarian failure and earlier bone loss, perhaps leading to lingering musculoskeletal problems. In addition, adjuvant tamoxifen may worsen menopause-related symptoms, including skeletal deterioration.23

Among 111 breast cancer survivors age > 60 years who were treated by radiation and surgery, survivors with higher self-esteem reported significantly better health-related quality of life; they also had more follow-up care.24 In another study, survey results were categorized by age and showed that the younger breast cancer survivors (ages 27–44 years) reported the worst quality-of-life outcomes.25 Our findings indicate that older survivors report more positive interpersonal relationships than younger survivors and are less likely to report that cancer adversely affected their overall health.

Today, breast cancer survivors are enjoying longer life spans because of more effective treatments and higher cure rates. However, these successful cancer therapies may carry several long-term sequelae. An increased awareness of the cancer history and cancer treatment of a survivor often requires adaptation of traditional medical practices. Cancer survivors, including breast cancer survivors, are becoming much more prevalent in the population, but their unique health needs are not widely acknowledged. Much additional work and research is needed to develop accurate and comprehensive information regarding the very long-term medical and social implications of breast cancer survivors. Information gathered from our investigation may serve as a basis for additional, more specific inquiries and analyses of other parameters, such as treatment modality or ethnicity characteristics.

Acknowledgements

We thank all patients who responded to the survey; their health care teams, who provided excellent care; Sarah Taylor for her contribution to the mailed survey; and Annette Allett for article preparation

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