Self-rated health and walking limitation as predictors of mortality in older women with breast cancer
Eng, Jessica Audrey
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Objective: To determine ifself-rated health modifies the effect ofbaseline walking limitation on 5- and 10-year mortality in older women with early stage breast cancer Design: Secondary analysis of a multicenter 10-year prospective study of older women with early stage breast cancer Setting: Sixty-two clinical centers in four geographic areas Participants: 585 women aged 65 years or older with Stage I to IIIa breast cancer who were followed by annual telephone calls for up to 10 years. Measurements: Baseline self-rated health, ability to walk several blocks, age, race, marital status, financial status, social support, comorbid conditions, body mass index, tumor stage, estrogen receptor (ER) status, initial therapy, and emotional health. The main outcome was all-cause mortality at 5 and 10 years as determined by National Death Index and Social Security Death Index. Results: Subjects at baseline were 17% age 80+, 48% stage II-IIIa, 25% ER negative, 42% with ≤1 comorbid condition. At the time of breast cancer diagnosis, 39% of women reported low self-rated health, and 28% reported limitations in walking several blocks. Those with low self-rated health and walking limitation had higher mortality rates than those with high self-rated health and without walking limitation (28.1% vs. 12.7% at 5 years, p = 0.0002; 67.8% vs. 34.9% at 10 years, p < 0.0001). In the adjusted regression model, risk of dying from any cause by 10 years was higher for women aged 80+ (HR 3.87, 95% CI 2.45, 6.11); age 70-79 (HR 1.54, 95% CI 1.06, 2.24); with inadequate finances (HR 1.73, 95% CI 1.13, 2.65); and with the combination of low self-rated health and walking limitation at baseline (HR 1.48, 95% CI 1.02, 2.15). Conclusion: In this study of older women with breast cancer, the combination of low self-rated health and limitation in walking several blocks at diagnosis was a predictor of all-cause mortality at 10 years of follow-up; this finding was independent of age, comorbidity, tumor characteristics, and treatment. These self-report measures can be easily assessed in clinical practice and may represent an effective strategy to improve treatment decision-making in older adults with cancer.
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