Article

The impact of functional limitations on long-term outcomes among African-American and white women with breast cancer: a cohort study

Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA.
BMJ Open (Impact Factor: 2.06). 10/2013; 3(10):e003232. DOI: 10.1136/bmjopen-2013-003232
Source: PubMed

ABSTRACT We examined the impact of functional limitations and functional decline during the first year following breast cancer diagnosis on the risk of mortality from breast cancer and other causes among African-American and white women, respectively.
The Health and Functioning in Women (HFW) cohort study.
Detroit, Michigan, USA.
A total of 162 African-American and 813 white women aged 40-84 years with newly diagnosed breast cancer identified through the Metropolitan Detroit Cancer Surveillance System over a 7-month period between 1984 and 1985 and followed for up to 28 years (median 11 years).
Risk of mortality from breast cancer and other causes.
Statistically significant increases in the risk of other-cause mortality were found for each unit increase in the number of self-reported functional limitations (HR=1.08, 95% CI 1.03 to 1.14), 0 vs ≥1 functional limitations (HR=1.47, 95% CI 1.13 to 1.91), difficulty in pushing or pulling large objects (HR=1.34, 95% CI 1.04 to 1.73), writing or handling small objects (HR=1.56, 95% CI 1.00 to 2.44), and walking half a mile (HR=1.60, 95% CI 1.19 to 2.14). Functional limitations and functional decline did not explain racial disparities in the survival of this cohort. Functional decline was associated with increased risk of other-cause mortality in women with regional and remote disease but not in women with localised disease. Whereas measures of functional limitation were not associated with breast cancer-specific mortality, each unit of functional decline (HR=1.17, 95% CI 1.05 to 1.31) and decline in the ability to sit ≥1 h (HR=2.06, 95% CI 1.13 to 3.76) were associated with increased risk of breast cancer-specific mortality. Measures of functional decline were associated with increased risk of breast cancer mortality in overweight and obese women, but not in women of normal weight.
Whereas functional limitations were associated with increased risk of other-cause mortality, functional decline was associated with increased risk of breast cancer mortality.

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    ABSTRACT: Objectives We examined the association between comorbidity and long-term mortality from breast cancer and other causes among African–American and white women with breast cancer. Methods A total of 170 African–American and 829 white women aged 40–84 years were followed for up to 28 years with median follow-up of 11.3 years in the Health and Functioning in Women (HFW) study. The impact of the Charlson Comorbidity Score (CCS) in the first few months following breast cancer diagnosis on the risk of mortality from breast cancer and other causes was examined using extended Cox models. Results Median follow-up was significantly shorter for African–American women than their white counterparts (median 8.5 years vs. 12.3 years). Compared to white women, African–American women had significantly fewer years of education, greater body mass index, were more likely to have functional limitations and later stage at breast cancer diagnosis, and fewer had adequate financial resources (all P < 0.05). Proportionately more African–American women died of breast cancer than white women (37.1% vs. 31.4%, P = 0.15). A positive and statistically significant time-varying effect of the Charlson Comorbidity Score (CCS) on other-cause mortality persisted throughout the first 5 years of follow-up (P < 0.001) but not for its remainder. Conclusions Higher CCS was associated with increased risk of other-cause mortality, but not breast cancer specific mortality; the association did not differ among African–American and white women.
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