Abstract B36: Comorbidities in breast cancer survivors: The role of race and socioeconomic factors

Abstract

Abstract Background Breast cancer survivors comprise the largest group of female cancer survivors. Comorbidity accounts for 40% of survival disparity in patients younger than 70 years. Many of these women face risk of developing additional comorbidities due in part to breast cancer therapies and/or lifestyle factors. Because breast cancer survivors with comorbid conditions have been shown to be at greater risk of mortality, understanding characteristics of women who are more likely to be diagnosed with comorbid conditions may help develop lifestyle interventions in this group. Purpose The goal of the study is to examine patterns of comorbid conditions in breast cancer survivors and identify socio-demographic factors that are associated with these conditions. Methods In an observation study, we recruited a convenience sample of women via hospital in reach (Washington DC and Detroit, MI) and outreach efforts (e.g. fliers, posters). Eligible women were: > 21 years, self-identified either as Black or White, English speaker, diagnosed with invasive non-metastatic breast cancer. A total of 678 potentially eligible patients were screened for the study, from which 477 resulted eligible and 395 (82.8%) consented. We excluded 26 women from subsequent analyses due to missing clinical data. The remaining 369 women comprised the final analytic data set. Measures Outcome: Comorbid conditions were abstracted from medical records and included cardiovascular, musculoskeletal, neurological/psychological, pulmonary, and gastrointestinal conditions. Predictors: Sociodemographic factors (race, age, education, marital status, type of insurance, and employment status). Analysis Descriptive statistics were used to characterize the sample. Bivariate (ANOVA, t-test) examined sociodemographic and treatment group differences on outcome. Univariate statistics examined the proportion of participants with specific comorbidities and χ2 tests examined whether the prevalence of specific comorbidities varied between demographic groups (race, education). Results At the time of diagnosis, seventy-three percent of women had at least one comorbidity. The three most common comorbidities were anemia, hypertension, and depression/anxiety. The average Body Mass Index (BMI) was 29.86 (SD=6.65) and 67% of the participants were overweight or obese. Participants with BMI ≤ 25 were less likely to have comorbidities compared to participants with BMI > 25. African-Americans had cardiovascular and pulmonary comorbidities at higher rates than Whites. In particular, African-Americans had hypertension (44% vs. 25%), peripheral vascular disease (21% vs. 3%), and COPD (10% vs. 2%), at higher rates than Whites (p<.05). Participants with lower education including those with ≤HS Diploma/GED and those with some college/Associate's degree had hypertension at higher rates (43% and 48% respectively) compared to those with a Bachelor's degree (26%) (p<.05). Conclusion Several socio-demographic disparities were noted with African Americans and those without a college degree having disproportionate rates of comorbidities. Since race and education has been associated with breast cancer outcomes, targeting these groups for lifestyle interventions (e.g., nutrition, exercise) may be beneficial. Limited data are available about interventions targeted towards survivors with comorbid conditions. Findings can inform targets for future interventions in breast cancer patients who are at risk for premature mortality and elevated morbidity post-cancer diagnosis and primary treatment. Citation Format: Krista Highland, Alejandra Hurtado de Mendoza, Ocla Kigen, Vanessa B. Sheppard. Comorbidities in breast cancer survivors: The role of race and socioeconomic factors. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B36. doi:10.1158/1538-7755.DISP13-B36