Racial disparities in functional disability among older women with newly diagnosed nonmetastatic breast cancer

Authors

  • Cynthia Owusu MD, MS,

    1. Division of Hematology/Oncology, Department of Medicine, Case Western Reserve School of Medicine, Cleveland, Ohio
    2. Case Comprehensive Cancer Center, Cleveland, Ohio
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  • Mark Schluchter PhD,

    1. Case Comprehensive Cancer Center, Cleveland, Ohio
    2. Department of Epidemiology and Biostatistics, Case Western Reserve School of Medicine, Cleveland, Ohio
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  • Siran M. Koroukian PhD,

    1. Case Comprehensive Cancer Center, Cleveland, Ohio
    2. Department of Epidemiology and Biostatistics, Case Western Reserve School of Medicine, Cleveland, Ohio
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  • Suzanne Mazhuvanchery BS,

    1. Division of Hematology/Oncology, Department of Medicine, Case Western Reserve School of Medicine, Cleveland, Ohio
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  • Nathan A. Berger MD

    Corresponding author
    1. Division of Hematology/Oncology, Department of Medicine, Case Western Reserve School of Medicine, Cleveland, Ohio
    2. Case Comprehensive Cancer Center, Cleveland, Ohio
    • Corresponding author: Cynthia Owusu, MD, MS, Case Western Reserve University, UHHS Seidman Cancer Center-BHC 5055, 11100 Euclid Avenue, Cleveland, OH 44106-5055; Fax: (216) 844-5234; Cynthia.owusu@case.edu

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Abstract

BACKGROUND

This study sought to assess racial differences in functional disability among older women with nonmetastatic breast cancer.

METHODS

In this cross-sectional study, between April 2008 and December 2012, women aged ≥ 65 years with newly diagnosed stage I through III breast cancer were recruited from ambulatory oncology clinics at an academic center. Prior to receiving any adjuvant treatment, participants completed a comprehensive geriatric assessment. The primary outcome was functional disability, defined as dependency in any basic or instrumental activity of daily living, categorized as “yes” or “no.” Logistic regression analyses were undertaken.

RESULTS

The study enrolled 190 women whose mean age was 75.0 years at diagnosis (standard deviation=7.0, range=65-93 years). Thirty-two percent were African American (AA), and 39% had functional disability. Controlling for age, participants with functional disability were more likely to be AA (versus non-Hispanic white), odds ratio=4.19, 95% confidence interval=2.12-8.27. Fifty-nine percent of the racial difference in functional disability was explained by a higher prevalence of lower income and education among AAs. In addition, the higher prevalence of chronic medical conditions and obesity among AAs, after accounting for socioeconomic factors, further explained 40% of the black–white difference in functional disability.

CONCLUSIONS

Among older women with newly diagnosed nonmetastatic breast cancer, functional disability is highly prevalent, and AAs are disproportionately affected. Interventions to optimize the functional status of at-risk individuals, particularly AAs, during and after cancer treatment may improve treatment tolerance and overall survival outcomes. Cancer 2013;119:3839–3846. © 2013 American Cancer Society.

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