Older Women with Breast Cancer Don’t Fare as Well
Older women with breast cancer may have other health problems, or 'comorbidities', which make them fare less well.
A study published online June 30 in the Journal of the National Cancer Institute reports these older breast cancer patients with comorbidities have higher mortality rates than their cohorts without the other health problems.
Breast cancer is the most common noncutaneous cancer worldwide among women aged 65 years or older. This group of breast cancer patients continues to grow as the population ages. Currently, more than one half of the 2.6 million women who are breast cancer survivors and of the 207 000 women newly diagnosed with breast cancer each year in the United States are older than 65 years.
Understanding how outcomes in breast cancer patients are influenced by competing comorbid diseases remains a challenge to its management. In this study, Jennifer L. Patnaik, Ph.D., of the University of Colorado Denver, Aurora, and colleagues looked at the association between each of 13 comorbidities and survival among breast cancer patients.
The 13 individual comorbidities included in the study were stroke, chronic obstructive pulmonary disease, chronic renal failure, congestive heart failure, dementia, diabetes, liver disease, heart attack, paralysis, peripheral vascular disease, previous cancer, rheumatoid arthritis, and ulcers.
Patnaik and colleagues used the Surveillance, Epidemiology, and End Results-Medicare database to identified 64,034 women age 66 years and older who were diagnosed with breast cancer between 1992 and 2000. Of these, 42% had a history of one or more of 13 comorbidities.
Each of the 13 comorbidities examined was associated with decreased overall survival and increased mortality. Those with a prior myocardial infarction had an adjusted hazard ratio [HR] of death = 1.11 (95% CI = 1.03 to 1.19, P = .006). Those with liver disease fared worse with an adjusted HR of death = 2.32 (95% CI = 1.97 to 2.73, P
When patients of age 66–74 years were grouped by stage and individual comorbidity status, patients with each comorbid condition and a stage I tumor had similar or poorer overall survival compared with patients who had no comorbid conditions and stage II tumors.
The authors conclude that comorbidities are important in predicting survival of breast cancer patients. They write that the study suggests that "careful attention to the effective management of comorbid conditions, as well as to the management of a patient's cancer, may result in longer overall survival for older breast cancer patients."
In an accompanying editorial, Worta McCaskill-Stevens, M.D., and Jeff Abrams, M.D., of the National Cancer Institute, Bethesda, Md., discuss the importance of studying older breast cancer patients, who account for a large proportion of women with the disease and who often have comorbidities. They conclude that the findings of this study "are provocative, suggesting that care should be individualized in patients with comorbidities and the diseases should be co-managed between oncologists and primary care physicians."
Jennifer L. Patnaik, Tim Byers, Carolyn Diguiseppi, Thomas D. Denberg, Dana Dabelea. The Influence of Comorbidities on Overall Survival Among Older Women Diagnosed With Breast Cancer. Journal of the National Cancer Institute, 2011; DOI: 10.1093/jnci/djr188
Worta McCaskill-Stevens and Jeffrey S. Abrams; Comorbidities in the Aging Breast Cancer Population: Are Current Assessments Leading to Improved Outcomes? JNCI J Natl Cancer Inst (2011) first published online June 30, 2011 doi:10.1093/jnci/djr239