29 Does self-reported functional limitation change in the year following breast cancer diagnosis?

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Background and Significance:While comorbidity, disability and compromised functional status are well known to increase with age, it is unclear to what extent the diagnosis and treatment of cancer play a role in activity limitation in older adults. We examined the prevalence of self-reported functional limitation in a breast cancer population, whether this limitation is attributed to breast cancer versus other coexisting illnesses, and how this attribution changes over time from early in treatment to 9-months later. Methods: 1011 patients with breast cancer were surveyed 3 months after diagnosis (baseline) and 933 of those patients were surveyed at 12 months after diagnosis (9 month follow up). In each survey, participants were asked whether or not they had each of 23 coexisting illnesses in addition to breast cancer. Participants were asked whether or not each illness, including breast cancer, caused significant activity limitation and, if yes for any illness, the person was considered to have functional limitation. Results: Of the 933 patients (mean age 62.7±12.3 years) who completed both baseline and follow up evaluations, 420 (45%) were aged 65 years and older. At baseline 478/933 (51%) had self-reported functional limitation and 68% of these attributed it to breast cancer whereas 31% attributed it to another co-existing condition. At follow up 411/933 (44%) had selfreported functional limitation and 41% attributed this limitation to breast cancer whereas 59% attributed it to other conditions (p< 0.001 comparing attribution to cancer between baseline and follow-up). At baseline, 237/420 (56%) of patients 65 years and older reported functional limitation compared with 241/513 (50%) of patients younger than 65 years (p = 0.005). Of those patients who reported limitation at baseline, 59% of older patients and 78% of younger patients attributed their limitation to breast cancer (p< 0.001). At follow up, 222/420 (53%) of older and 189/513 (37%) of younger patients reported functional limitation (p< 0.001), with 27% of older patients compared with 57% of younger patients (p< 0.001) attributing limitation to breast cancer. Conclusion: Self-reported functional limitation is prevalent 3 months after breast cancer diagnosis, being attributed primarily to breast cancer. This limitation declines at 9 months follow up, with a larger proportion of patients attributing limitation to other coexisting illnesses, potentially related to risks of treatment, and a smaller proportion attributed to breast cancer itself. The shift of attribution of limitation from cancer to coexisting illnesses is more pronounced in the population older than 65 years.