Older Breast Cancer Survivors Research Articles

Assessment of Gait Speed and Timed Up and Go Measures as Predictors of Falls in Older Breast Cancer Survivors.

Background:Older breast cancer survivors are at an increased risk of loss of postural balance and accidental falls, however, the ability of clinical mobility measures to predict falls has not been determined. The purpose of this study was to examine the prognostic ability, sensitivity, and specificity to predict accidental falls in measures of gait speed and functional mobility in older breast cancer survivors.Methods:Thirty-four breast cancer survivors 65 years and older performed 3 measures of gait speed (GS) (usual, fast, dual-task) and Timed Up and Go (TUG) (TUG, TUG-Cognitive, TUG-Manual). Follow-up calls were made 3 months after testing to track falls.Results:The area under the curve (AUC) was below 0.5 for all GS measures, indicating poor predictive ability and all GS measures had low sensitivity and specificity to predict falls. All TUG measures had AUC values above 0.5. The cutoff score with the best sensitivity/specificity to predict falls was: TUG-Cognitive = 11.32 seconds, Sens = 0.64, Spec = 0.80; TUG-Manual = 9.84 seconds, Sens = 0.71, Spec = 0.65.Conclusion:When assessing fall risk in older breast cancer survivors, performance on the TUG and TUG-Cognitive are able to predict falls.

Overview of REJOIN: A Clinical Trial to Use Exercise to Relieve Joint Pain in Older Breast Cancer Survivors

Aromatase Inhibitors (AIs) are recommended for survival in hormone-sensitive breast cancer survivors, yet are underutilized, especially in older survivors. Joint pain is a prevalent AI-related symptom that is associated with low adherence. The aims for this randomized clinical trial (n=76) are to: 1) adapt a self-management (exercise + education) intervention for older survivors planning to take AIs; 2) Test the effect of a pilot intervention on arthralgia; and 3) Test its effect on AI medication adherence behaviors. We will adapt a program for seniors that includes bi-weekly 60-minute sessions of supervised exercise plus 30 minutes of education. The 16-week program includes: 8-weeks in person plus 8-weeks at home with phone counseling. We will conduct geriatric plus baseline assessment of exercise, joint pain, and AI adherence (repeated 4, 6 and 12 months). More research with geriatric survivors is required to address treatment needs and to promote survival. Part of a symposium sponsored by the Cancer and Aging Interest Group.

Cardiovascular Screening and Lipid Management in Breast Cancer Survivors.

Cardiovascular disease (CVD) is the leading cause of death among breast cancer (BC) survivors. BC survivors are at increased risk of CVD due to a higher prevalence of risk factors. Current data are limited on the cardiovascular screening practices and lipid management in this population in primary care settings. A retrospective case control study was performed with 105 BC survivors and 210 matched controls (based on age and medical comorbidities of diabetes, hypertension, and hyperlipidemia). BC survivors were established with primary care practices within a large academic institution and had completed primary cancer treatment. Data on screening for CVD and lipid management were collected via a retrospective chart review. The average BC survivor was 63 years old, with 9 years since diagnosis. Compared with matched controls, BC survivors had more cholesterol screening (88% vs 70%, P < .001) and active statin prescriptions (63% vs 40%, P < .05) if indicated by the Atherosclerotic Cardiovascular Disease Calculator. There were no differences in CVD screening in White and African American BC survivors. However, African American BC survivors were more likely to have hypertension (P < .01) and have a body mass index in the overweight and obese category (P < .001) than White BC survivors. Older BC survivors were more likely to receive cholesterol screening. This study demonstrates that BC survivors who have an established primary care provider have improved cholesterol screening and statin therapy based on their risk of developing chronic diseases.

Presence and Distress of Chemotherapy-Induced Peripheral Neuropathy Symptoms in Upper Extremities of Younger and Older Breast Cancer Survivors.

The purposes of this study were to determine whether the presence of upper extremity chemotherapy-induced peripheral neuropathy (CIPN) symptoms (burning, pins/needles, numbness, pain, and skin crawls) among breast cancer survivors (BCS) varied according to age (≤45 years or 55-70 years) and to examine age group differences in upper extremity CIPN symptom distress. The study was a secondary analysis of younger (n=505) and older (n=622) BCS. Inclusion criteria were age of ≤45 years or 55-70 years; patient at 3-8 years postdiagnosis; patient received the chemotherapy regimen of paclitaxel, doxorubicin, and cyclophosphamide; and patient did not have recurrence. The Symptom Survivor Checklist was used to assess presence and distress of upper extremity CIPN symptoms. Analyses explored whether age group predicted CIPN symptom presence and distress while controlling for sociodemographic and medical variables. Older BCS reported fewer pins/needles, numbness, and pain symptoms (odds ratios: 0.623-0.751). Heart disease (odds ratios: 1.59-1.70) and progesterone-negative breast cancer (odds ratio: 0.663) were significantly associated with one or more CIPN symptoms. Symptom distress ratings did not differ by age groups; both age groups indicated distress from CIPN symptoms, with 25% or more reporting distress as "moderately" or "quite a bit." Younger BCS reported more upper extremity CIPN symptoms. BCS in both groups continued to report bothersome CIPN symptoms years after treatment. Study findings will assist clinicians in identifying BCS at higher risk for upper extremity CIPN as well as inform development of appropriate tailored interventions to mitigate these symptoms and facilitate restoration to age-related baseline function, thereby improving quality of life for BCS.

Cognitive Dysfunction in Older Breast Cancer Survivors: An Integrative Review.

Approximately 60% of the more than 3.8 million breast cancer survivors (BCSs) living in the United States are 60 years or older. Breast cancer survivors experience many symptoms including cognitive dysfunction; however, little is known regarding how age affects these symptoms. This integrative review was conducted to synthesize the literature on cognitive dysfunction in older BCSs. The purpose was to (1) describe the prevalence of objective and subjective cognitive dysfunctions and (2) examine factors associated with cognitive dysfunction in older BCSs. Whittemore and Knafl's integrative review methodology was used to examine cognitive dysfunction in BCSs 60 years or older. Twelve quantitative studies were included. Up to 41% of older BCSs experienced cognitive dysfunction on neuropsychological examination, and up to 64% reported cognitive dysfunction on subjective measures pretreatment. Approximately half of older BCSs experienced cognitive decline from pretreatment to posttreatment regardless of cognitive measure. The domains most impacted were memory, executive functioning, and processing speed. Objective and subjective cognitive dysfunctions were associated with age, comorbidities, chemotherapy receipt, sleep, neuropsychological symptom cluster, frailty, and quality of life. Cognitive dysfunction among older BCSs was common both prior to and following treatment. Cognitive dysfunction was associated with multiple factors that are compounded in the aging population and could be detrimental to quality of life and independent living. Early assessment and intervention by healthcare providers, including nurses, for cognitive dysfunction in older BCSs are essential. Future research should focus on evidence-based interventions for cognitive dysfunction incorporating the unique needs of older BCSs.

Association of Current Opioid Use With Serious Adverse Events Among Older Adult Survivors of Breast Cancer

National efforts to improve safe opioid prescribing focus on preventing misuse, overdose, and opioid use disorder. This approach overlooks opportunities to better prevent other serious opioid-related harms in complex populations, such as older adult survivors of cancer. Little is known about the rates and risk factors for comprehensive opioid-related harms in this population. To determine rates of multiple opioid-related adverse drug events among older adults who survived breast cancer and estimate the risk of these events associated with opioid use in the year after completing cancer treatment. This retrospective cohort study used 2007 to 2016 Surveillance, Epidemiology and End Results-Medicare data from fee-for-service Medicare beneficiaries with first cancer diagnosis of stage 0 to III breast cancer at age 66 to 90 years from January 1, 2008, through December 31, 2015, who completed active breast cancer treatment. Data were analyzed from October 31, 2019, to June 10, 2020. Repeated daily measure indicating possession of any prescription opioid supply in Medicare Part D prescription claims. Adjusted risk ratios (aRRs), estimated using modified Poisson generalized estimating equation models, for adverse drug events related to substance misuse (ie, diagnosed opioid abuse, dependence, or poisoning), other adverse drug events associated with opioid use (ie, gastrointestinal events, infections, falls and fractures, or cardiovascular events), and all-cause hospitalization associated with opioid supply the prior day, controlling for patient characteristics. Among 38 310 women included in the study (mean [SD] age, 74.3 [6.3] years), there were 0.010 (95% CI, 0.008-0.011) adverse drug events related to substance misuse per 1000 person-days, 0.237 (95% CI, 0.229-0.245) other adverse drug events associated with opioid use per 1000 person-days, and 0.675 (95% CI, 0.662-0.689) all-cause hospitalizations per 1000 person-days. Opioid use was associated with increased risk of adverse drug events related to substance misuse (aRR, 14.62; 95% CI, 9.69-22.05; P < .001), other adverse drug events related to opioid use (aRR, 2.50; 95% CI, 2.11-2.96; P < .001), and all-cause hospitalization (aRR, 2.77; 95% CI, 2.55-3.02; P < .001). In a dose-response effect, individuals with high daily opioid doses had consistently higher risks of all study outcomes compared with individuals who had low opioid doses. Compared with days with no opioid exposure, the risk of any adverse drug event related to substance misuse was 3.4-fold higher for individuals with a current opioid supply ≥50 mg morphine equivalent dose per day (aRR, 3.40; 95% CI, 2.47-4.68; P < .001), while the risk was 2.3-fold higher for individuals with 1 to 49 mg morphine equivalent dose per day (aRR, 2.29; 95% CI, 1.89-2.77; P < .001). These findings suggest that among older adults who survived breast cancer, continued prescription opioid use in the year after completing active cancer treatment was associated with an immediate increased risk of a broad range of serious adverse drug events related to substance misuse and other adverse drug events associated with opioid use. Clinicians should consider the comprehensive risks of managing cancer pain with long-term opioid therapy.

Abstract 5756: Examining the relationship between medication utilization and health-related quality of life (HRQOL) among breast cancer patients with comorbidities: A Surveillance Epidemiology and End Results and Medicare Health Outcomes Survey (SEER-MHOS) analysis

Abstract Background The population of 17 million cancer survivors in the US is projected to steadily increase by 29% in 2029. With advancing age, cancer incidence increases; therefore, the increase of cancer survivors aged 65 and older is expected to place undue burden on the healthcare system. Older cancer patients have higher prevalence of comorbid conditions, which contributes to a higher overall illness burden compared to younger cancer patients and may require complex medication management during cancer treatment. Cancer patients with multiple comorbid conditions report lower health-related quality of life (HRQOL). Women with breast cancer (BC) experience noticeable comorbidity prevalence rates (30%) that can negatively influence HRQOL and increase breast cancer mortality by 20-50%. The causes of HRQOL deficits are likely multifactorial, including demographic and clinical factors which require further investigation. Furthermore, research examining the relationship between medication management, comorbidities, and HRQOL in cancer patients, including stratifying the potential role of obesity that contributes to changes in HRQOL, is limited. Further research addressing the medication management of comorbid conditions can improve understanding of HRQOL in BC patients. Objectives To investigate the association of the medication management of hypertension, diabetes, and respiratory conditions on BC survivor's HRQOL. The secondary objective is to evaluate the role of obesity in medication management for these conditions and resultant changes in HRQOL. Methods Patients diagnosed with Stage I-IV BC between 2007-2016 were identified from the Surveillance Epidemiology and End Results (SEER) and Medicare Health Outcomes Survey (MHOS; SEER-MHOS) data resource. Descriptive statistics and multivariate models, including demographics, clinical characteristics, and Medicare Part D claims, was used to evaluate medication management and potential underlying associations. HRQOL was assessed using the VR-12. Obesity was calculated from self-reported height and weight at the time of survey. Results The study population for this analysis includes 1,016 breast cancer patients diagnosed between 2007-2016 in the SEER-MHOS dataset with continuous Part D coverage one year before and after diagnosis. Among these patients, 85% reported at least one comorbid condition. Further analysis is in progress. Conclusions Understanding the potential aspects of treatment that influence HRQOL can provide further insights into patient-reported experiences and may improve standards of care to support older BC survivors with chronic comorbid conditions. Citation Format: Melissa A. Bruno, Roxanne Jensen, Catherine Wang, Dannielle Kelley, Erin Kent, Donna R. Rivera. Examining the relationship between medication utilization and health-related quality of life (HRQOL) among breast cancer patients with comorbidities: A Surveillance Epidemiology and End Results and Medicare Health Outcomes Survey (SEER-MHOS) analysis [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5756.

Mammography use in relation to comorbidities and functional limitations among older breast cancer survivors

We sought to examine associations of mammography utilization with comorbidities and functional limitations in older breast cancer survivors. Female breast cancer survivors (N = 1064) identified in the 2016 and 2018 Behavioral Risk Factor Surveillance System (BRFSS) who were aged ≥ 65years were included for this study. Mammography use, major comorbidities (diabetes mellitus, myocardial infarction, coronary heart disease, stroke, chronic obstructive pulmonary disease, arthritis, chronic kidney disease, depression, and malignancy other than breast cancer), functional limitations (impairment of vision, audition, cognition, and mobility), and other covariates were measured by self-report. We used multivariable logistic regression models to calculate adjusted odds ratios (aOR) of comorbidities and functional limitations. Subgroup analyses were conducted by age (65-74 vs. ≥ 75years) and survival time (< 10 vs. ≥ 10years), and interactions were examined by Wald tests. Of the 1064 respondents, 841 (79.0%) had comorbidities, 418 (39.3%) had functional limitations, and 744 (69.9%) underwent mammography last year. Overall, the mean age was 73.8years (SD = 5.1years) and 91.4% were white. The multivariable model identified inverse associations with mammography use for functional limitations (≥ 2 vs. 0: aOR = 0.61, 95% CI = 0.39-0.95, p-trend = 0.09) but not comorbidities (≥ 2 vs. 0: aOR = 0.91, 95% CI = 0.61-1.35, p-trend = 0.62). The Wald test did not find any significant interaction. A higher burden of functional limitations, not comorbidities, is associated with a lower rate of mammography use among older breast cancer survivors. Interventions are needed to individualize surveillance mammography among older breast cancer survivors based on their health status.

The impact of the use of opioids among older breast cancer survivors and adverse events.

12098 Background: Older adults and cancer survivors are underrepresented in the literature underpinning recent opioid prescribing guidelines. As prevention of unnecessary persistent opioid use and inadvertent opioid-related harms gains importance in clinical practice, it is necessary to fully capture the risks of opioid related adverse events among patients with cancer pain. The objective of this study was to determine the association between opioid use after cancer diagnosis and comprehensive opioid-related adverse events among older adult breast cancer survivors. Methods: We conducted a retrospective cohort study using Surveillance, Epidemiology, and End Results tumor registry data linked with Medicare administrative claims data from 2007-2016 of women with newly diagnosed non-metastatic breast cancer. The study observation period was the year following a patient’s end of active cancer treatment. The primary exposure was a daily measure of opioid exposure based on Part D prescription claims. The primary outcomes were daily indicators of all-cause hospitalization, substance use event and a composite of other opioid-related adverse events (infections, gastrointestinal events, falls/fractures, cardiovascular events) and each component of the composite adverse event. We estimated the association of current opioid use and the immediate risk of an outcome event the following day using modified Poisson generalized estimating equation models. We adjusted for patient demographics, cancer characteristics and cancer treatments received. Results: We found that opioid exposure more than doubled the immediate risk of all-cause hospitalization (aRR = 2.77; 95%CI = 2.57, 2.99; p &lt; 0.001) and having a composite adverse event (aRR = 2.50; 95%CI = 2.18, 2.87; p &lt; 0.001) and dramatically increases the immediate risk of a substance use event (aRR = 14.26; 95%CI = 7.11, 28.59; p &lt; 0.001). We find consistent results when looking at individual components of the composite adverse event measure. Conclusions: Older adult breast cancer survivors with continued prescription opioid use in the year after completing active cancer treatment experienced an immediate increased risk of all-cause hospitalization, substance use events, and myriad opioid-related adverse effects.

Improve, a community-based exercise intervention versus support group to improve functional and health outcomes among older African American and non-hispanic white breast cancer survivors from diverse socioeconomic backgrounds: Recruitment strategies and baseline characteristics.

e24052 Background: We conducted an exercise study to IMPROVE health outcomes in older breast cancer survivors (BCS) from diverse racial and socioeconomic backgrounds. Here, we report cohort recruitment strategies and baseline characteristics. Methods: ‘IMPROVE’ is a randomized trial, designed to evaluate a group-based exercise intervention compared to support group. Participants were ≥ 65 years, had stage I-III breast cancer and within five years of treatment completion. Enrollment target was 220 participants, 25% in each of four strata defined by race (AA versus Non-Hispanic Whites [NHW]) and SES (low vs. high). Participants were recruited through hospital-based tumor registries, the state tumor registry or direct referrals. Results: Between October 2016 and November 2019, 7487 patients were screened, 4790 were potentially eligible, 230 were consented and 213 randomized into the study. The Eligible-to-Randomization rates were 4.4% overall, and 84%, 8%, and 2% for recruitment utilizing direct referrals, hospital and state registries, respectively. Median age of the randomized cohort was 70 years (range: 65-88 years) and included 25% AA/Low SES, 20% AA/High SES, 19% NHW/Low SES and 36% NHW/High SES Older BCS. Compared with registry-eligible patients, directly referred patients were more likely to be AA vs. NHW (41% vs. 19%, p = 0.003) and to accept study participation (88% vs. 16%, p &lt; 0.0001). Conclusions: Direct referrals resulted in the highest recruitment yield and was the most effective strategy for recruiting AA patients. Behavioral intervention studies seeking to target older BCS from racial minority and SES disadvantaged backgrounds should focus on strategies that foster direct referrals to study participation. Clinical trial information: NCT02763228 .

Patient reported outcomes in older breast cancer survivors.

12072 Background: The majority of breast cancer patients are age 66 years or older at diagnosis, yet little is known about the symptom burden of older breast cancer survivors. Methods: Using the same process as for SEER-Medicare, data from the Texas Cancer Registry (TCR) and Medicare claims were linked. From this TCR-Medicare dataset, patients age 65 years and older at diagnosis, with localized or regional breast cancer, diagnosed in 2012 and 2013, and still alive in 2018 were identified. To assess long-term outcomes, a mailed survey, which included selected questions from the NCI’s PRO-CTCAE question bank, was sent to 4591 eligible patients along with a $10 gift card. Non-responders were sent a follow-up questionnaire at 4-6 weeks and 8-10 weeks after initial mailing. The percentage reporting symptoms, overall and by treatment received, are described. Results: 1594 survivors completed the questionnaire (35% response rate). Median time from diagnosis to survey completion was 67 months. 70% of responders were age 65-74, 26% age 75-84, and 3% age 85+ at diagnosis. 84% were non-Hispanic white, 6% black, and 9% Hispanic. 77% had localized stage disease and 23% had regional disease at diagnosis. 58% had lumpectomy, 36% had mastectomy, and 2% reported no surgery. 77% had ER+ breast cancer. 28% received adjuvant chemotherapy. 48% had Part D claims for adjuvant endocrine therapy. PROs are reported in Table, overall and by use of chemotherapy and endocrine therapy. Conclusions: Older breast cancer survivors, particularly those who were treated with chemotherapy, experience a high symptom burden. [Table: see text]

Primary care physician's confidence and coordination regarding the survivorship care for older breast cancer survivors.

To examine primary care physician's (PCPs) internal (confidence, training) and external (communication, receipt of survivorship care plans (SCPs)) regarding their provision of survivorship care to older breast cancer survivors METHOD: A web-based questionnaire was completed individually by PCPs about their training and areas of survivorship they address under their care. A subset of survey participants was interviewed about survivorship care for older breast cancer survivors, care coordination, and areas of improvement regarding SCPs. PCPs (n = 29) had an average 13.5years in family practice. Forty-five percent surveyed as "somewhat confident" or "not confident" evaluating and managing the late effects of cancer treatment, and 25% surveyed as "somewhat confident" or "not confident" addressing the chronic comorbidities of older breast cancer survivors. More than half of PCPs surveyed that they reach out to their patients' oncologist "a little" or "none of the time" and that they receive SCPs "a little" or "none of the time." Semi-structured interviews also indicated that many PCPs did not receive a SCP from their patients' oncologists and that communication between the two providers regarding survivorship care was poor. Participants indicated that PCP confidence in providing survivorship care is lacking and that lack of training, infrequent communication with oncologists, and underutilization of SCPs may contribute to this lack of confidence. These findings provide insight into the possible need for a well-defined shared care model, which has been encouraged but not always a routine part of survivorship care in various practice settings.

IMPROVE, a community-based exercise intervention versus support group to improve functional and health outcomes among older African American and non-Hispanic White breast cancer survivors from diverse socioeconomic backgrounds: Rationale, design and methods

BackgroundAfrican Americans (AA) and socioeconomic status (SES) disadvantaged older breast cancer survivors (BCS) are more likely to experience poor functional and health outcomes. However, few studies have evaluated the putative beneficial effects of exercise on these outcomes in older racial minority and SES-disadvantaged BCS. MethodsThis is a mixed-methods study that includes a randomized-controlled trial, “IMPROVE”, to evaluate a group-based exercise intervention compared to a support group program in older BCS, followed by post-intervention semi-structured interviews to evaluate the intervention. The trial aims to recruit 220 BCS with 55 in each of four strata defined by race (AA versus Non-Hispanic Whites) and SES (disadvantaged vs. non-disadvantaged). Participants are ≥65 years old and within five years of treatment completion for stage I-III breast cancer. Participants are randomized to a 52-week, three sessions/week, one-hour/session, moderate intensity aerobic and resistance group exercise intervention, (n = 110) or a 52-week, one hour/week, support group intervention [attention-control arm], (n = 110). The first 20 weeks of both programs are supervised and the last 32 weeks, unsupervised. The primary outcome is the change in Short Physical Performance Battery (SPPB) Scores at 20 weeks from baseline, between the two arms. Secondary outcomes include change in SPPB scores at 52 weeks, change in body composition and biomarkers, at 20 and 52 weeks from baseline, between arms. DiscussionResults of the trial may contribute to a better understanding of factors associated with recruitment, and acceptability, and will inform future exercise programs to optimally improve health outcomes for older BCS.

Perspectives of Survivorship Care Plans Among Older Breast Cancer Survivors: A Pilot Study.

The Commission on Cancer’s standard 3.3 represents a paradigm shift in the care of cancer survivors, recommending that survivors receive a treatment summary and survivorship care plan (SCPs). A focus on older breast cancer survivors is needed, as they are the majority of the breast cancer population and their experiences and perspectives of SCPs is limited in the literature. This pilot study utilized a mixed methods approach (focus groups and self-report questionnaire data) to gather information on older (≥65 years) breast cancer survivors’ perspectives of their SCPs, cancer survivorship, and communication with their health-care providers. The questionnaire was completed individually by the participants prior to the focus group and contained items on basic demographics and their health status following cancer treatment. The focus groups indicated that only a minority of women actually developed a SCP. Those who developed a SCP in collaboration with their providers valued the personal care and attention received. However, some participants reported poor communication with their providers and within their health-care team, resulting in frustration and confusion. Participants’ suggestions for ideal SCPs included better education and personalization, particularly in appropriate nutrition and exercise, and managing side effects and comorbidities. Lastly, the women believed that additional long-term care resources, such as health coaches, were important in improving their survivorship. These findings provide insight into enhancing the content, communication, and application of SCPs to improve the survivorship experience of older breast cancer survivors.

Cognitive function prior to systemic therapy and subsequent well-being in older breast cancer survivors: Longitudinal findings from the Thinking and Living with Cancer Study.

To investigate the relationships between self-reported and objectively measured cognitive function prior to systemic therapy and subsequent well-being outcomes over 24 months in older breast cancer survivors. Data were from 397 women aged 60 to 98 diagnosed with non-metastatic breast cancer in the Thinking and Living with Cancer Study recruited from 2010-2016. Cognitive function was measured at baseline (following surgery, prior to systemic therapy) using neuropsychological assessments of attention, processing speed, and executive function (APE), learning and memory (LM), and the self-reported FACT-Cog scale. Well-being was measured using the FACT-G functional, physical, social, and emotional well-being domain scales at baseline and 12 and 24 months later, scaled from 0 (low) to 100 (high). Linear mixed-effects models assessed the relationships between each of baseline APE, LM, and FACT-Cog quartiles with well-being scores over 24 months, adjusted for confounding variables. At baseline, older survivors in the lowest APE, LM, and FACT-Cog score quartiles experienced poorer global well-being than those in the highest quartiles. At 24 months, older survivors tended to improve in well-being, and there were no differences according to baseline APE or LM scores. At 24 months, mean global well-being was 80.3 (95% CI: 76.2-84.3) among those in the lowest vs 86.6 (95% CI: 83.1-90.1) in the highest FACT-cog quartile, a clinically meaningful difference of 6.3 points (95% CI: 1.5-11.1). Among older breast cancer survivors, self-reported, but not objective cognitive impairments, were associated with lower global well-being over the first 2 years of survivorship.

Body image in older breast cancer survivors: A systematic review.

Breast cancer is the most common cancer among women world-wide. In North America survival rates are >80%, resulting in a large population of survivors. The goal of this review was to systematically explore the literature to identify the status of body image and factors that can impact the body image of older breast cancer survivors. A systematic review of the literature was conducted and registered with PROSPERO (CRD42019133617). EMBASE and PubMed were searched for articles including terms related to "body image" and "breast cancer." Duplicates were removed and the remaining 322 abstracts were screened. Articles published before 2000, were off-topic, or those that were non-primary research articles were excluded. Sixty-nine remaining full-length articles were screened for language, gender and location. Seven articles underwent quality assessment of which five passed and were reviewed in depth. The remaining two articles were briefly discussed. The literature review suggests that body image is considered important in older BCS and that body image may impact or be impacted by several factors including age, menopausal status, mental health, treatment modality and exercise. Additionally, themes of dealing with physical changes and the length of time women are impacted following treatment were explored. Our findings highlight that older women may be at an advantage in terms of being post-menopausal, however concerns surrounding physical and emotional changes affecting body image are indeed present. Future studies on breast cancer survivorship should consider the inclusion of body image as an outcome measure in addition to including individuals representing a wide range of ages.

Trajectory of recurrent falls in post-menopausal breast cancer survivors and in matched cancer-free controls.

Cross-sectional studies suggest that falls are prevalent among older breast cancer survivors. However, fall risk in this population has not been comprehensively examined. Therefore, we compared fall risk in older women post-breast cancer diagnosis to fall risk before cancer diagnosis and to risk in cancer-free matched controls. Among 2019 women in the Women's Health Initiative with localized breast cancer diagnosed at age ≥ 60years with fall assessment data for 3years pre-diagnosis and 3years post-diagnosis, recurrent fall risk post-diagnosis was compared to risk in 2019 cancer-free controls matched by age, year of WHI entry, and baseline fall frequency. Generalized estimating equations under a logistic regression model were used to compare fall recurrence in breast cancer survivors and controls. Multi-variable models were adjusted for the matching factors, race/ethnicity, body mass index, and multiple chronic conditions. In breast cancer survivors aged 70.8years (mean) at diagnosis, over the 3-year pre-diagnosis interval, recurrent falls were reported by 18.5%. Over the 3-year post-diagnosis interval, recurrent falls were reported by 21.8% of breast cancer survivors and 20.0% of controls over the same time period (P = 0.27). Recurrent fall risk did not differ between breast cancer survivors and control women (OR 1.07, 95% CI 0.92-1.25), even after multi-variable adjustment. In contrast to prior reports, older breast cancer survivors were not more likely to experience recurrent falls than age-matched counterparts. These findings underscore the need for incorporation of cancer-free control populations in survivorship studies to distinguish cancer sequelae from processes related to aging.

Effect of Surgeon Factors on Long-Term Patient-Reported Outcomes After Breast-Conserving Therapy in Older Breast Cancer Survivors.

The effect of surgeon factors on patient-reported quality-of-life outcomes after breast-conserving therapy (BCT) is unknown and may help patients make informed care decisions. We performed a survey study of women aged ≥ 67years with non-metastatic breast cancer diagnosed in 2009 and treated with guideline-concordant BCT, to determine the association of surgeon factors with patient-reported outcomes. The treating surgeon was identified using Medicare claims, and surgeon factors were identified via the American Medical Association Physician Masterfile. The primary outcome was patient-reported cosmetic satisfaction measured by the Cancer Surveillance and Outcomes Research Team (CanSORT) Satisfaction with Breast Cosmetic Outcome instrument, while secondary outcomes included BREAST-Q subdomains. All patient, treatment, and surgeon covariables were included in a saturated multivariable linear regression model with backward elimination applied until remaining variables were p < 0.1. Of 1650 women randomly selected to receive the questionnaire, 489 responded, of whom 289 underwent BCT. Median age at diagnosis was 72years and the time from diagnosis to survey was 6years. The mean adjusted CanSORT score was higher for patients treated by surgical oncologists than patients treated by non-surgical oncologists (4.01 [95% confidence interval [CI] 3.65-4.38] vs. 3.53 [95% CI 3.28-3.77], p = 0.006). Similarly, mean adjusted BREAST-Q Physical Well-Being (91.97 [95% CI 86.13-97.80] vs. 83.04 [95% CI 80.85-85.22], p = 0.006) and Adverse Radiation Effects (95.28 [95% CI 91.25-99.31] vs. 88.90 [95% CI 86.23-91.57], p = 0.004) scores were better among patients treated by surgical oncologists. Specialized surgical oncology training is associated with improved long-term patient-reported outcomes. These findings underscore the value of specialized training and may be useful to patients choosing their care team.

Symptom burden among older breast cancer survivors: The Thinking and Living With Cancer (TLC) study.

Little is known about longitudinal symptom burden, its consequences for well-being, and whether lifestyle moderates the burden in older survivors. The authors report on 36-month data from survivors aged ≥60years with newly diagnosed, nonmetastatic breast cancer and noncancer controls recruited from August 2010 through June 2016. Symptom burden was measured as the sum of self-reported symptoms/diseases as follows: pain (yes or no), fatigue (on the Functional Assessment of Cancer Therapy [FACT]-Fatigue scale), cognitive (on the FACT-Cognitive scale), sleep problems (yes or no), depression (on the Center for Epidemiologic Studies Depression scale), anxiety (on the State-Trait Anxiety Inventory), and cardiac problems and neuropathy (yes or no). Well-being was measured using the FACT-General scale, with scores from 0 to 100. Lifestyle included smoking, alcohol use, body mass index, physical activity, and leisure activities. Mixed models assessed relations between treatment group (chemotherapy with or without hormone therapy, hormone therapy only, and controls) and symptom burden, lifestyle, and covariates. Separate models tested the effects of fluctuations in symptom burden and lifestyle on function. All groups reported high baseline symptoms, and levels remained high over time; differences between survivors and controls were most notable for cognitive and sleep problems, anxiety, and neuropathy. The adjusted burden score was highest among chemotherapy-exposed survivors, followed by hormone therapy-exposed survivors versus controls (P<.001). The burden score was related to physical, emotional, and functional well-being (eg, survivors with lower vs higher burden scores had 12.4-point higher physical well-being scores). The composite lifestyle score was not related to symptom burden or well-being, but physical activity was significantly associated with each outcome (P<.005). Cancer and its treatments are associated with a higher level of actionable symptoms and greater loss of well-being over time in older breast cancer survivors than in comparable noncancer populations, suggesting the need for surveillance and opportunities for intervention.

A Retrospective Study to Identify Factors Associated with Disability Status Among Older Breast Cancer Survivors

A Retrospective Study to Identify Factors Associated with Disability Status Among Older Breast Cancer Survivors