Co-morbidity and predictors of health status in older rural breast cancer survivors

Abstract

PurposeMore than 66% of the 200,000 newly diagnosed annual breast cancers in the US occurs in women over 55 years. Treatment advances result in excellent survival, yet older breast cancer survivors with co-morbidity may live longer, but not better after cancer. Decline in physical function, increased social isolation, and diminished economic resources increase vulnerability among older women. Rural women represent an underserved population. The purpose is to examine associations between comorbidity and predictors of health status among older rural breast cancer survivors.MethodsBaseline data of 331 BCS age 55–90 years enrolled in the Rural Breast Cancer Survivors Study. Four surveys were used for data collection. Self-reported prescription medications were used as proxy for co-morbidity. Bivariate tests of association and multivariable recursive partitioning techniques were used for analysis.ResultsMean number of prescription medication categories reported was 3.68 (SD = 2.3; range = 0–12). Common prescription categories were: anti-hormonal, anti-hypertensive, and cholesterol- reducing agents. 69% was overweight or obese. BMI >31 was significantly associated with both poorer physical and mental health. Multivariate analyses indicated physical health status was predicted by BMI, comorbid conditions, social support, and adverse changes in economic lifestyle. The same variables, with the exception of BMI, were predictors of mental health status.ConclusionsAssessing co-morbid conditions, mental health status, social support, and economic burden after breast cancer treatment may better inform cancer survivorship care and comprehensive geriatric assessment.

Evaluating Survivorship Experiences and Needs Among Rural African American Breast Cancer Survivors

“…Second, our finding of lack of knowledge about the usual and expected late effects of treatment was another consistent theme identified by a growing cadre of investigators [13,14,16,18,19]. Participants expressed that they did not receive essential survivorship education about lymphedema, fatigue, hormonal side effects, sexuality, and body image.…”

Rural–Urban Residence and Stage at Breast Cancer Diagnosis Among Postmenopausal Women: The Women's Health Initiative

“…1 Finally, Markossian and Hines used 1992-2007 data from urban (Atlanta) and rural Georgia National Cancer Institute's SEER program registries (n = 23,500); however, their results are not generalizable and are based on aggregate county-level data on rural-urban residence. 43 Although the existing literature on the impact of ruralurban residence on stage at breast cancer diagnosis has not examined potential moderation by social support and social strain, these social factors have been shown to impact general as well as cancer-specific health behaviors [21][22][23][24][25][26][27] and health outcomes. [28][29][30] Given this literature, it is theoretically plausible that these factors might exacerbate (social strain) or buffer against (social support) the effects of rural residence on stage at breast cancer diagnosis.…”

“…21,22 Furthermore, a sizeable literature has identified social support as an important protective factor for breast cancer development and progression, [23][24][25][26] and as a predictor of physical activity and health status among rural breast cancer survivors. 27 In contrast, strained relationships have been associated with earlier mortality, 28,29 and socially isolated women have been shown to have higher breast cancer mortality than their socially integrated counterparts. 30 Given this, it is plausible that the association between rural-urban residence and stage at breast cancer diagnosis is buffered by social support and/or exacerbated by social strain, but no studies have tested these hypotheses.…”

Predictive values of two frailty screening tools in older patients with solid cancer: a comparison of SAOP2 and G8

“…Lower perceived social support is generally associated with higher depressive symptoms and lower quality of life [ 30 , 31 ], especially in cancer patients compared to the general population [ 30 , 32 ]. Thus, social vulnerability represents a key factor for patient's compliance and the effectiveness of chemotherapy regimens [ 33 , 34 ].…”