Abstract
Purpose
Breast cancer patients often experience a decline in physical functioning following cancer diagnosis. Although most patients recover after treatment, some patients do not. These changes may be magnified in older women with comorbid conditions and could impact survival outcomes.
Methods
We used longitudinal data from a prospective cohort study of women 65+ years of age, recruited shortly after diagnosis of early stage breast cancer, to examine changes in self-reported physical functioning measured with the Physical Function Index (PF-10) of the Medical Outcomes Study Short Form-36. Outcomes were constructed for small (0.2 SD), medium (0.5 SD), and large (0.8 SD) declines in the PF-10 measurement over two intervals: (1) 3 to 15 months following cancer diagnosis, encompassing treatment and early recovery, and (2) 3 to 27 months following cancer diagnosis, in order to detect sustained recovery versus persistent decline. Cox-proportional hazards regression was used to examine association between survival and decline in PF-10 scores.
Results
A large (>0.8 SD) decline in PF-10 scores from 3 to 27 months predicted shorter 10-year survival (hazard ratio = 1.34, 95 % confidence interval 1.1–1.6). Persistent decline at 27 months was associated with less education, higher baseline PF-10, increased comorbidity, and higher body mass index.
Conclusions
Older women with breast cancer who experience a large and persistent decline in PF-10 are at increased mortality risk. Future research should examine the value of clinical assessment of physical function as a marker for mortality and test interventions to prevent decline in physical function to improve post-treatment survival outcomes.
Implications for Cancer Survivors
Many breast cancer survivors experience a decline in physical functioning in the year following their cancer diagnosis. While the majority of patients recover in the year after treatment is completed, individuals who experience a persistent decline in physical functioning without recovery are at risk of functional decline and early mortality. Our results highlight the importance of assessing functional status to identify those at risk for functional decline, and suggest a potential role for early intervention in these individuals.
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References
American Cancer Society: Breast cancer facts and figures 2010.
Ganz PA, Hahn EE. Implementing a survivorship care plan for patients with breast cancer. J Clin Oncol. 2008;26:759–67.
Garman KS, Pieper CF, Seo P, et al. Function in elderly cancer survivors depends on comorbidities. J Gerontol A Biol Sci Med Sci. 2003;M1119–24.
Hewitt M, Rowland JH, Yancik R. Cancer survivors in the United States: age, health and disability. J Gerontol A Biol Sci Med Sci. 2003;58:82–91.
Kornblith AB, Herndon II JE, Weiss RB, et al. Long-term adjustment of survivors of early-stage breast carcinoma, 20years after adjuvant chemotherapy. Cancer. 2003;98:679–89.
Ganz PA, Kwan L, Stanton AL, et al. Physical and psychosocial recovery in the year after primary treatment of breast cancer. J Clin Oncol. 2011;29:1101–9.
Deimling GT, Arendt JA, Kypriotakis G, Bowman KF. Functioning of older, long-term cancer survivors: the role of cancer and comorbidities. J Am Geriatr Soc. 2009;57:S289–92.
Cohen HJ. Functional assessment and the cancer survivor: something old, something new. J Natl Cancer Inst. 2010;102:1450–1.
Extermann M. Interaction between comorbidity and cancer. Cancer Control. 2007;14:13–22.
Keeler E, Guralnik JM, Tian H, Wallace RB, Reuben DB. The impact of functional status on life expectancy in older persons. J Gerontol A Biol Sci Med Sci. 2010;65:727–33.
Lunney JR, Lynn J, Foley DJ, et al. Patterns of functional decline at the end of life. JAMA. 2003;289:2387–92.
Sweeney C, Schmitz KH, Lazovich D, et al. Functional limitations in elderly female cancer survivors. J Nat Cancer Inst. 2006;98:521–9.
Ganz PA, Kwan L, Stanton AL, et al. Quality of life at the end of primary treatment of breast cancer: first results from the moving beyond cancer randomized trial. J Natl Cancer Inst. 2004;96:376–87.
Silliman RA, Guadagnoli E, Rakowski W, et al. Adjuvant tamoxifen prescription in women 65 years and older with primary breast cancer. J Clin Oncol. 2002;20:2680–8.
Ware Jr JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Med Care. 1992;30:473–83.
Ware JE. SF-36 Health survey manual and interpretation guide. Boston: Nimrod; 1993.
Biorner JB, Wallenstein GV, Martin MC, et al. Interpreting score differences in the SF-36 Vitality scale: using clinical conditions and functional outcomes to define the minimally important difference. Curr Med Res Opin. 2007;23:731–9.
Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale: Lawrence Erlbaum Associates; 1988.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis. 1987;40:373–83.
Schag CA, Ganz PA, Heinrich RL. Cancer Rehabilitation Evaluation System–short form (CARES-SF): a cancer specific rehabilitation and quality of life instrument. Cancer. 1991;68:1406–13.
Schafer JL, Olsen MK. Multiple imputation for multivariate missing-data problems: a data analysts’s perspective. Multivar Behav Res. 1998;33:545–71.
Rubin DB. Multiple imputation for non-response in surveys. New York: Wiley; 1987.
Schafer JL. NORM. 1999. http://www.stat.psu.edu/-jls/misoftwa.html. Accessed August 10, 2007.
Bernaards CA, Belin TR, Schafer JL. Robustness of a multivariate normal approximation for imputation of incomplete binary data. Stat Med. 2007;26:1368–82.
Schafer JL. Analysis of incomplete multivariate data. London: CRC; 1997. p. 147–92.
Arndt V, Merx H, Sturmer T, Stegmaier C, Ziegler H, Brenner H. Age-specific detriments to quality of life among breast cancer patients one year after diagnosis. Eur J Cancer. 2004;40:673–80.
Braithwaite D, Satariano WA, Sternfeld B, Hiatt RA, Ganz PA, Kerlikowska K, et al. Long-term prognostic role of functional limitation among women with breast cancer. J Natl Cancer Inst. 2010;102:1–10.
Patterson RE, Squib N, Natarajan L, et al. Improvement in self-reported physical health predicts longer survival among women with a history of breast cancer. Breast Cancer Res Treat. 2011;127:541–7.
Klepin HD, Geiger AM, Tooze JA, et al. Physical performance and subsequent disability and survival in older adults with malignancy: results from the health, aging and body composition study. J Am Geriatr Soc. 2010;58:76–82.
Satariano WA, Ragheb NE, Buck KA, Swanson GM, Branch LG. Aging and breast cancer: a case–control comparison of instrumental functioning. J Aging Health. 1989;1:209–33.
Wenzel BL, Fairclough DL, Brady MJ, Cella D, Garrett KM, Kluhsman BC, et al. Age-related differences in the quality of life of breast carcinoma patients after treatment. Cancer. 1999;86:1768–74.
Ferrucci L, Harris TB, Guralnik JM, et al. Serum IL-6 level and the development of disability in older persons. J Am Geriatr Soc. 1999;47:639–46.
Ferrucci L, Penninx BW, Volpato S, et al. Change in muscle strength explains accelerated decline of physical function in older women with high interleukin-6 serum levels. J Am Geriatr Soc. 2002;50:1947–54.
Reuben DB, Cheh AI, Harris TB, et al. Peripheral blood markers of inflammation predict mortality and functional decline in high-functioning community-dwelling older persons. J Am Geriatr Soc. 2002;50:638–44.
Taaffe DR, Harris TB, Ferrucci L, Rowe J, Seeman TE. Cross-sectional and prospective relationships of interleukin-6 and C-reactive protein with physical performance in elderly persons: MacArthur studies of successful aging. J Gerontol A Biol Sci Med Sci. 2000;55:M709–15.
Zhu S, Patel KV, Bandinelli S, Ferrucci L, Guralnik JM. Predictors of interleukin-6 elevation in older adults. J Am Geriatr Soc. 2009;57:1672–7.
Brinkley TE, Leng X, Miller ME, et al. Chronic inflammation is associated with low physical function in older adults across multiple comorbidities. J Gerontol A Biol Sci Med Sci. 2009;64:455–61.
Bower JE, Ganz PA, Tao ML, et al. Inflammatory biomarkers and fatigue during radiation therapy for breast and prostate cancer. Clin Cancer Res. 2009;15:5534–40.
Earle CC, Burstein HJ, Winer EP, Weeks JC. Quality of non-breast cancer health maintenance among elderly breast cancer survivors. J Clin Oncol. 2003;21:1447–51.
LIFE Study Investigators, Pahor M, Blair SN, Espeland M, et al. Effects of a physical activity intervention on measures of physical performance: results of the lifestyle interventions and independence for Elders Pilot (LIFE-P) study. J Gerontol A Biol Sci Med Sci. 2006;61:1157–65.
Acknowledgments
We would like to thank Dr. Tom Belin for valuable input on our analysis. This research was supported by a career development award from The ASCO Cancer Foundation and the Breast Cancer Research Foundation, as well as by grants from the Breast Cancer Research Foundation and Susan G. Komen for the Cure to Dr. Ganz. The original project was supported by grants CA106979, CA70818, and CA84506, and CA92395 supported Dr. Silliman's work on this analysis, all from the National Cancer Institute.
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Sehl, M., Lu, X., Silliman, R. et al. Decline in physical functioning in first 2 years after breast cancer diagnosis predicts 10-year survival in older women. J Cancer Surviv 7, 20–31 (2013). https://doi.org/10.1007/s11764-012-0239-5
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DOI: https://doi.org/10.1007/s11764-012-0239-5