Post-breast Cancer Diagnosis Research Articles

Newly Diagnosed Mental Health Disorders in Patients With Breast Cancer Receiving Radiation Therapy

ObjectivesPatients with a mental health disorder (MHD) have higher age-adjusted mortality compared to the general population. Few reports investigate factors contributing to MHD among breast cancer patients receiving radiotherapy. Here, we report the incidence of acquired MHD after the diagnosis of breast cancer and treatment with radiotherapy. MethodsUtilizing a single-institution, prospectively maintained database, we analyzed patients with breast cancer treated with radiotherapy between 2012 and 2017. We cross-referenced these patients with newly acquired ICD-10 MHD codes within 3 years post-breast cancer diagnosis. The study included baseline NCCN distress tool scores and area deprivation index (ADI). Univariate (UVA) and multivariable (MVA) Cox regression analyses were conducted to evaluate factors impacting new MHD onset. ResultsOf the 967 included patients, 318 (33%) developed an MHD after their breast cancer diagnosis, which were predominately anxiety (45.1%) and depression (20.1%) related, with a median (IQR) time to diagnosis of 30 (24–33) months. UVA showed lymph node-positive disease, receipt of chemotherapy, receipt of a mastectomy, high comorbidity index, divorced status, retired status, and fourth-quartile ADI as significant predictors. On MVA, only receipt of chemotherapy (HR=1.70, p=0.014) and divorced status (HR=2.04, p=0.009) remained significant. Fourth-quartile ADI, retired status, and high comorbidity index showed trends towards significance (HR=1.78, p=0.065; HR=1.46, p=0.094; HR=1.41, p=0.059, respectively). On MVA examining the effects of the radiotherapy type on MHD, whole breast with regional nodal irradiation (WBI+RNI) (HR=2.31, p=0.015) and post-mastectomy radiotherapy (PMRT) (HR=1.88, p=0.024) were both strong predictors of MHD development. Additionally, an NCCN distress tool score of >3 was also predictive of MHD onset. ConclusionIn this cohort, one in three patients with localized breast cancer developed a new MHD, predominantly related to anxiety and depression. MHD risk was higher among divorced patients, those receiving chemotherapy, and patients receiving PMRT or WBI+RNI. These findings highlight the importance of future studies and targeted interventions to support this vulnerable population.

Characteristics of early short-term traditional Chinese medicine in breast cancer patients: A population-based cohort study.

Traditional Chinese medicine (TCM) is frequently utilized as a complementary therapy for breast cancer patients. TCM primarily involves the use of Chinese herbal products (CHPs), which consist of single or multiherb formulas with diverse therapeutic effects documented in medical classics. The study aims to investigate the association between medication possession ratios to CHPs within 2-year post breast cancer diagnosis and 5-year survival, to explore the potential beneficial class effect of TCM. This retrospective population-based cohort study included newly diagnosed breast cancer patients between 2003 and 2006, identified from the National Health Insurance Research Database of Taiwan. Logistic regression and Cox proportional hazards analysis were utilized to assess the likelihood of medication possession ratios (MPRs) for CHPs and to examine the association of variables with 5-year survival. A total of 3472 patients with breast cancer were included. Patients who had MPR of 1% to 9% and 10% to 19% for CHPs within 2 years after breast cancer diagnosis exhibited better 5-year survival rates compared with those who did not use CHPs (adjusted hazard ratio [aHR] 0.69, 95% confidence interval [CI] 0.55-0.86, p = 0.001; aHR 0.50, 95% CI 0.28-0.88, p = 0.016). Furthermore, the use of TCM formulations specifically targeting insomnia, such as Tian-wang-bu-xin-dan and Suan-zao-ren-tang, demonstrated a significantly positive association with survival (aHR 0.71, 95% CI 0.52-0.98, p = 0.035) among patients who were short-term users of CHPs (MPR of 1% to 19%). Short-term use of TCM (ie, MPR to CHPs 1~19%) within 2-year post breast cancer diagnosis present positive association with survival outcome. Tian-wang-bu-xin-dan and Suan-zao-ren-tang may have benefits to 5-year survival, but their causality still need further investigation.

Navigating norms and expectations: the influence of culture on Latino couples and their interpersonal communication and coping post-breast cancer diagnosis

ABSTRACT Objectives Cultural norms shape expectations, care, and communication. Effective interpersonal communication is a prominent predictor of patient-partner cancer management, improving the overall quality of life for the dyad by increasing their ability to cope with cancer. However, couples-based cancer interventions often do not consider cultural factors. Additionally, although Latinas have a high incidence of breast cancer, few studies focus on Latino couples and the influence of culture in cancer care interventions. This study focuses on understanding how Latino culture’s norms and expectations influence how couples communicate and cope post-breast cancer diagnosis. Design This study conducted interviews and focus groups with a purposive sample of Spanish-speaking Latina breast cancer survivors (N = 21) and intimate partners (N = 5). In the focus group and interviews, participants were asked about the influence cancer had on their relationship, with specific questions focusing on communication within the dyad. The study team used CARV: Community-Engaged Adaptation with Rapid Analysis and Visualization framework to identify cultural considerations and recurring themes. Results The cross-cutting cultural considerations and themes found were: the negative influence of gendered and social norms on managing emotions and coping; the silent struggle with physical intimacy; and the inability to discuss the topic – or even say the word ‘cancer.’ Conclusion Understanding the role of Latino culture in how couples cope with and communicate about cancer post-diagnosis is essential. This understanding will help strengthen the dyad by assisting with positive interpersonal support, which contributes to a better quality of life. These findings will also help providers assist dyads in navigating the cancer diagnosis and journey, helping to lessen the interpersonal stress and tensions that can occur after diagnosis.

Breast cancer survivorship and employment in Ireland: Legislative systems and the return to work of women with breast cancer.

Breast cancer is the most common invasive cancer in females worldwide. While work is important for well-being, 84% of women in Ireland temporarily or permanently cease working up to six months post-breast cancer diagnosis. Under Irish law, there is a right to reasonable work accommodations, however paid sick leave has only recently been state-mandated. Legislation internationally varies across nations. The aim of this study was to explore the experiences of women who have had breast cancer returning to, and/or remaining in work, in the context of employment legislation. Fifteen women with breast cancer, fifteen healthcare professionals, and nine employers nationwide participated in a qualitative-descriptive design, using semi-structured interviews. Interviews were audio-recorded, transcribed, and data analysed using thematic analysis. Thirty-nine participants were recruited. A prominent theme from interviews was that most women with breast cancer and healthcare professional cohorts were not aware of employment rights in the context of cancer diagnoses. This is in contrast to employers. Experiences of sick leave and pay entitlements varied amongst women with breast cancer with financial pressure and expediated the return to work evident for some participants. Most women did not report any discrimination on returning to the workplace, although there were examples of indirect discrimination where unfair expectations were being placed on women by colleagues. Education and awareness on employment rights and entitlements during and after cancer treatment is warranted. This could be incorporated into work-focused interventions to support those living with and beyond cancer to transition back into the workplace.

Trends in health-related quality of life of female breast cancer survivors using the Medical Expenditure Panel Survey (MEPS), 2008-2016.

In recent years, breast cancer detection and treatment have advanced. As a result, increased attention to breast cancer survivorship should have improved their health-related quality of life (HRQoL). Our aim was to examine the trends in the HRQoL of female breast cancer survivors between 2008 and 2016, to determine whether or not the increased focus on survivorship has translated into improved HRQoL. Furthermore, stratified analyses were conducted by race/ethnicity and age group and these were compared to a similar group of women without a breast cancer history. Repeated cross-sectional analyses using the Medical Expenditure Panel Survey between 2008 and 2016 were conducted. Pooled ordinary least squares (OLS) regression was used to examine the trends in physical component scores (PCS-12) and mental component scores (MCS-12) among breast cancer survivors and a similar population of women without a breast cancer history. Analyses stratified by race/ethnicity and age group were also conducted. Among breast cancer survivors, after adjusting for confounders, there was no change in PCS-12 scores over time, but the MCS-12 scores increased by 0.27 points (95% CI 0.09-0.45). Those without a history of breast cancer had mean PCS-12 scores that were 0.13 points greater each year (95% CI 0.02-0.24) while their mean MCS-12 scores were 0.10 (95% CI 0.00-0.21) points greater each year. After stratifying by race/ethnicity, Hispanic breast cancer survivors had a small increase in PCS-12 (β: 0.65; 95% CI 0.01-1.29), and MCS-12 scores (β: 0.70; 95% CI0.06-1.33) over time. Similar small effects were found when stratified by age group, both among breast cancer survivors and those without a history of breast cancer. The younger age group (< 50years) reported poorer MCS-12 than the older population (age 50years and above). Our study generated findings showing the trends in the HRQoL of breast cancer survivors and compared these to a similar population of women without a history of breast cancer. This paper highlights the importance of focusing on the mental health of young breast cancer survivors to improve their prospects at a good quality of life post-breast cancer diagnosis and treatment.

Insomnia and Susceptibility to Depressive Symptoms and Fatigue in Diverse Breast Cancer Survivors.

Background: Nearly 40% of breast cancer survivors have insomnia, yet, information how this condition affects their quality of life is lacking. We examined the association between insomnia and depressive symptoms and fatigue in breast cancer survivors.Methods: Participants were recruited from a community health plan. We conducted a cross-sectional analysis to examine the association between current insomnia (using Insomnia Severity Index [ISI]) and current depressive symptoms (using Inventory of Depressive Symptomology [IDS]) and fatigue (using Fatigue Symptom Inventory [FSI]) in 315 breast cancer survivors who did not have major depressive disorder. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) using multivariable logistic regression.Results: The cohort included 30% minority women whose median time since breast cancer diagnosis was 6 years. Survivors with current insomnia symptoms (ISI ≥8) had a sixfold greater odds of current depressive symptoms (IDS >14, OR = 5.98, 95% CI: 3.04–11.76), after adjusting for lifetime insomnia history (OR = 2.01, 95% CI: 1.03–3.94) and perceived stress (OR = 6.37, 95% CI: 2.48–16.32). Insomnia symptoms were markedly associated with moderate fatigue (FSI >3, OR = 5.02, 95% CI: 2.66–9.44). Ever use of antidepressants or sleep medications post-breast cancer diagnosis was not associated with lower odds of current depressive symptoms or feeling fatigued in those with insomnia symptoms.Conclusion: Current insomnia symptoms were strongly correlated with current depressive symptoms and fatigue. Survivorship care plans should consider incorporating insomnia screening to that may potentially enhance quality of life domains.

Influence of Traditional Chinese Medicine on Medical Adherence and Outcome in Estrogen Receptor (+) Breast Cancer Patients in Taiwan: A Real-World Population-Based Cohort Study

BackgroundMedical adherence is often higher in clinical trials than in real world practice. The aim of this study was to investigate the effects of traditional Chinese medicine (TCM) on medical adherence to hormonal therapy (HT) and survival outcome in ER (+) breast cancer patients in Taiwan. Subjects and methodsUsing a nationwide longitudinal population-based database, we enrolled patients with newly diagnosed ER-positive breast cancer who had received HT, and followed for up to 5 years (N = 872). Medication adherence in terms of medication possession ratios (MPR) and patient outcome were evaluated with or without TCM exposure. We applied logistic regression and Cox proportional hazards (PH) analysis to identify factors, including TCM exposure, associated with adherence to HT and mortality. ResultsMPR to HT in general decreased over the 5-year period post breast cancer diagnosis. Both TCM and MPR to HT ≥ 80% were significantly associated with reduced risk of breast cancer-associated mortality. Subgroup analysis revealed that TCM annual visits ≥ 3 times with CHP prescription 1~90 days per year affected mortality reduction most significantly (HR: 0.26; 95% CI = 0.08–0.83; p < 0.05) compared to other TCM use. In contrast, using TCM (either short-term or long-term) was not associated with MPR in HT. ConclusionsOur results supported the potential advantage of TCM on breast cancer-associated mortality, whereas TCM use does not compromise medical adherence to HT. This study offers important insights in integrative therapy for HT in patients with estrogen receptor (+) breast cancer.

Abstract 5749: The association between physical health-related quality of life, physical functioning and risk of contralateral breast cancer

Abstract Background: Physical limitations and disability among older cancer patients can lead to suboptimal treatment and surveillance for secondary cancers. Our objective was to evaluate the effects of poor physical health-related quality of life (PQOL) and physical functioning (PF) on contralateral breast cancer (CBC) risk among older women diagnosed with unilateral breast cancer (UBC). Methods: We performed a nested case-control study within a cohort from the Surveillance, Epidemiology and End Results Medicare Health Outcomes Survey (MHOS) database. Women were required to have first primary UBC without prophylactic contralateral mastectomy. Among 2,938 women ages 65 years and older with stages I-III UBC between 1997 and 2011, we identified 100 subsequent CBC cases and 915 controls using incidence density sampling without replacement matched on age, race, and quarter-year of diagnosis. PQOL and PF were determined from survey responses to the Medical Outcomes Trust Short Form 36 component scores. Conditional logistic regression models were used to estimate relative risks (RR) and 95% confidence intervals (CI) for metachronous CBC. Results: Cases and controls were similar with respect to comorbidities, stage, surgery and radiation treatments but differed by hormone receptor status (ER/PR-negative, cases 23% and controls 11%). Cases had lower mean PQOL (-1.8; 95% CI -4.3, 0.7) and PF (-2.2, 95% CI -4.9, 0.5) component scores, but these differences were not statistically significant. In multivariable models, estimates suggest increased CBC risk for women in the lowest quartile of PQOL compared to those in the upper quartile (RR=1.8; 95% CI 0.8, 4.3). Compared to women in the upper quartile of physical functioning scores, women in the lower three quartiles had a 2.6-fold (95% CI 1.2, 5.9) increased risk of CBC. Conclusions: Our findings indicate that low physical health-related quality of life is common among older women diagnosed with breast cancer, and poor physical functioning is related to risk of CBC. Efforts to understand and minimize declines in physical functioning post-breast cancer diagnosis may help optimize treatment strategies to reduce the risk of this adverse outcome. Citation Format: Nita Mukand, Nadia Nabulsi, Ali Alobaidi, Alemseged Asfaw, Brian C. Chiu, Naomi Y. Ko, Gregory S. Calip. The association between physical health-related quality of life, physical functioning and risk of contralateral breast cancer [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 5749.

Immunological changes with perception of cold in breast cancer (BC) patients.

e12559 Background: Tumor-bearing mice “feel colder” than non-tumor bearing mice and prefer to be at thermoneutral temperatures. Cold stress results in immunosuppressive tumor microenvironment [decrease in CD8+T-cells, increase in myeloid derived suppressor cells and T-regulatory cells]. Cytokines play a significant role in modulating these immune cells. Breast cancer (BC) patients frequently report feeling excessively cold under ambient temperature. We examined the association between cytokine levels and thermal discomfort symptoms in BC patients in the Women’s Health After Breast Cancer (ABC) Study treated at Roswell Park Comprehensive Cancer Center. Methods: 424 stage I-III BC patients were identified. Standard demographics, body mass index (BMI), race, grade, histological subtype, tumor size, stage, nodal status, treatment received, and menopausal status were recorded. Peripheral blood was prospectively collected at diagnosis and one year post diagnosis and analyzed for a panel of 27 cytokines. Patients completed a questionnaire reporting symptom of “feeling cold when others are fine” using a Likert scale one year post BC diagnosis. Relationships between cytokines levels as tertiles and symptoms of “feeling cold” were evaluated using logistic regression. Change in cytokine levels from the time of BC diagnosis to one year post were also evaluated [ &gt; 20% decrease, no change (-20 to +20%), and &gt; 20% increase]. Results: Overall, 195/424 (46%) patients reported “feeling cold”. There were no differences in patient and tumor characteristics between patients who reported “feeling cold” vs “not cold.” Interestingly, 53.4% patients on chemotherapy reported “feeling cold” (p &lt; 0.05). At baseline, higher IL-17E and IL-6 were associated with decreased perception of feeling cold (p &lt; 0.05, p &lt; 0.01). At one year post diagnosis, higher TNF-β was associated with decreased perception of feeling cold (p &lt; 0.05). Changes in IL-22 and IL-33 were associated with increased perception of feeling cold (p &lt; 0.05, p &lt; 0.05). Multivariate model adjusted for age, race, BMI, histological subtype, stage, grade, treatment and menopausal status showed a trend towards decreased cold perception with higher IL-6 but was not statistically significant. Conclusions: We observe significant differences in pro-tumorigenic IL-6 and anti-tumorigenic IL-17E &amp; TNF-β cytokines in BC patients reporting thermal discomfort. This suggests avenues for using thermal therapies to modulate inflammatory cytokine production in breast cancer.

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.

Abstract P5-12-04: Association of adjuvant endocrine therapy with diabetes among women with postmenopausal breast cancer in the Women’s Health Initiative (WHI)

Abstract Background: In postmenopausal women, use of hormone therapy is associated with a lower incidence of diabetes (DM). The association of adjuvant endocrine therapy (AET) with DM has not been well studied among women treated for early stage breast cancer. The objective of this study was to examine the association of AET with risk of developing DM among postmenopausal women who developed breast cancer. Methods: 5,013 postmenopausal women from the Women’s Health Initiative diagnosed with non-metastatic breast cancer who were diabetes-free at cancer diagnosis and who had information on use of AET were included. AET use was gathered using 2 methods: 1) review of medication inventories for use of tamoxifen or aromatase inhibitors (AI) and 2) review of the Life and Longevity after Cancer (LILAC), a supplemental questionnaire used from 2009-2010 to gather treatment information from women who developed cancer. Results from these 2 collection methods were analyzed separately due to the timing of the surveys as well as data granularity (i.e. LILAC queried use of AET, not type). The primary outcome of interest for this study was diabetes-free survival, which was calculated from the date of breast cancer diagnosis to first diagnosis of DM. Participants who did not develop DM after breast cancer were censored at their last follow-up visit or date of death. Cox proportional hazards models were used to compute hazard ratios (HR) and 95% confidence intervals (CI). Results: After 10.4 median year’s follow-up post breast cancer diagnosis, 13% (632/5,013) of participants developed DM. Of the 2,646 who had medication inventory data, 1,352 (51%) reported AI use and 1,449 (55%) reported tamoxifen use. Participants who reported use of AIs were 13% more likely to develop DM than participants who did not use AIs (HR=1.13, CI=0.91-1.39). Participants who reported use of tamoxifen were 11% less likely to develop DM than those who did not use tamoxifen (HR=0.89, CI=0.72-1.11). Of the 3,769 participants with LILAC data from the supplemental questionnaire, 2,543 (67%) reported use of AET; these participants were 25% more likely to develop DM than those who did not use AET (HR=1.25, CI=1.02-1.53). When plotted over time, the risk of diabetes in AET users versus non-users was identical at 5 years (5% v 5%, respectively), was 35% higher at 10 years (12% v 9%, respectively), and 30% higher at 15 years (18% v 14%, respectively) (log-rank p=0.029). Conclusion: DM has not been reported as an adverse event in women on AET. Our data suggest an association of AET with DM among postmenopausal women with early stage breast cancer. When looking at specific types of AETs, the risk was marginally increased for AIs but marginally decreased for tamoxifen, with risk more apparent in subsequent years. These data have significance for survivorship care. Citation Format: Joanne E Mortimer, Rebecca A Nelson, Laura Kruper, Kathy Pan, Christina M Dieli Conwright, Aladdin H Shadyab, Lewis Kuller, Barbara Howard, Rowan T Chlebowski. Association of adjuvant endocrine therapy with diabetes among women with postmenopausal breast cancer in the Women’s Health Initiative (WHI) [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-12-04.

Clinical and psychometric validation of the BreSAS questionnaire module for symptom assessment among breast cancer survivors

The large number of women surviving many years post breast cancer (BC) diagnosis has heightened interest in studying long-term effects of cancer on quality of life (QoL). Several cancer-specific health-related measures have been developed, but these may not be appropriate for long survivors. This study evaluates the reliability and clinical and psychometric validity of the BreSAS questionnaire (BQ) among BC survivors. The BQ is a quick, simple ten-item module for the assessment of long-term physical, psychological, sexual, and cognitive effects that may influence QoL. The total BreSAS score ranks from 0 to 100, with a low score indicating a better QoL. Patients complete the BQ, the FACT-ES questionnaire, and case report forms for clinical and socio-demographic data during follow-up visits. Reliability and clinical and psychometric validity of the questionnaires are assessed by correlation analyses and exploration of known group comparisons. From September 2015 to February 2016, 149 patients from three Italian oncology units were enrolled. Baseline questionnaires were returned from all, and 134 patients (89%) completed the BQ and FACT-ES in less than 15min. For reliability, Cronbach's alpha coefficients for each scale were greater than 0.70 in all analyzed symptoms. Convergent validity of BQ showed by Pearson's r demonstrated a high correlation between intensity of symptoms and QoL, especially for pain and depression. No data were provided about reproducibility with test-retest study. The BQ demonstrates sufficient validity and reliability to support its use to assess patient-reported symptoms during planned follow-up clinical visits among BC survivors. Further full validation studies are needed.

Abstract P1-08-10: Insulin resistance and breast cancer incidence and mortality in postmenopausal women

Abstract Background:Obese postmenopausal women are at higher breast cancer risk potentially driven by hyperinsulinemia. However, reports of insulin level associations with breast cancer incidence and survival are inconsistent. Therefore, we examined associations among insulin resistance by homeostasis model assessment-insulin resistance (HOMA-IR) index and incident breast cancer, deaths from breast cancer, and deaths after breast cancer in postmenopausal women participating in the Women's Health Initiative (WHI). Patients and Methods:From the 161,808 postmenopausal women, aged 50-79 years, enrolled at 40 US clinical centers from 1993 through1998 in WHI clinical trials or the observational study, 22,837 with available fasting serum insulin and glucose by the same methodology and no prior breast cancer represent the current study population. The exposure was insulin resistance (HOMA-IR index) as [fasting insulin (qIU/ml) times fasting glucose (mg/dL) / 22.5. Survival by cause was determined by central medical record or death certificate review, enhanced by National Death Index queries. Breast cancers, initially ascertained by serial survey, were confirmed by medical record review. Associations between HOMA-IR quartiles and breast cancer outcomes were examined using Cox multi- variate proportional hazards models with results reported as hazard ratios (HR) and 95% confidence intervals. Results: At entry, women in the highest HOMA-IR quartile were more likely to be Black, have lower education level, have higher body mass index (BMI), higher waist circumference ≥ 88 cm and lower physical activity levels, but have lower calculated five-year breast cancer risk. After 18.1 years median follow-up from randomization with 1,148 incident breast cancers, breast cancer incidence was higher in women in the highest, compared to the lowest, HOMA-IR index quartile (HR 1.39 95% CI 1.14 -1.69, P = 0.0012). Of the women with incident breast cancer, 353 (31%) have died, with cause of death available on 334 (95% of cases) where breast cancer was the most common cause of death (33%); followed by cardiovascular disease (24%); and other cancers (13%). With median post-breast cancer diagnosis follow-up of 10.5 years, breast cancer mortality was examined from breast cancer diagnosis. No association was found between death from breast cancer and HOMA-IR. However, women with breast cancer in the highest HOMA-IR quartile, compared to women in the lowest, were significantly more likely to experience death after breast cancer from any cause (HR 1.45 95% CI 1.00 - 2.09, P = 0.0488) and were at somewhat higher risk of death from cardiovascular disease (HR 1.51 95% CI 0.67 - 3.41) and other causes (HR 1.93 95% CI 0.87-4.27). Conclusion:In postmenopausal women, higher insulin resistance is associated with higher breast cancer incidence and more deaths after breast cancer, likely due to insulin influence on several causes of death. However, deaths from breast cancer, even in this older postmenopausal population, remains a major factor limiting survival which needs to be addressed. The findings suggest insulin resistance represented a potential intervention target for postmenopausal women with early stage breast cancer. Citation Format: Chlebowski RT, Pan K, Mortimer J, Cespedes Feliciano EM, Gunter MJ, Hurria A, Rohan T, Vitolins MZ, Adams-Campbell L, Ho G, Cheng T-YD, Nelson R. Insulin resistance and breast cancer incidence and mortality in postmenopausal women [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-08-10.

Abstract 4236: Charlson comorbidity index scores before and after breast cancer diagnosis among a racially diverse cohort of women

Abstract Background: We examined racial/ethnic differences in Charlson comorbidity index scores (CCI) pre and post breast cancer (BC) diagnosis among Non-Hispanic White (NHW), Hispanic, and African-American (AA) women. Methods: We conducted a retrospective chart review to calculate CCI scores (excluding age and BC) for 387 women diagnosed with BC between December 2013 and June 2017 at the University of Illinois Hospital and Health Sciences System. Using all available electronic records, we used International Chronic Disease 9 and 10 codes to determine presence or absence of a chronic condition pre and post BC diagnosis. Data was collected on race, ethnicity, stage, age at diagnosis, and vital status. Logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI) for associations between race/ethnicity and CCI among BC patients. Results: Of the 387 BC patients, 63% were AA, 15% were Hispanic, and 16% were NHW. Mean ages were 56, 56, and 57 years, respectively. 217 women had a CCI of 0 (no comorbidity), 101 women had a CCI ≥1 at their BC diagnosis (mean CCI 4.8), and 69 women developed at least one chronic condition after their BC diagnosis (mean CCI 5.2; with a mean duration of follow-up of 1.9 years). AA women had a higher average CCI score compared to Hispanic and NHW women (CCI= 4.3 versus 3.9 &amp; 3.3, p=0.006). Although not statistically significant, mean CCI scores were higher for Hispanic versus NHW women (CCI= 3.9 vs 3.3, p=0.08). At the time of their BC diagnosis, AA and Hispanic women were 2.2 times more likely to have a CCI ≥ 1 compared to NHW women [(AA vs NHW 95% CI (1.3-3.9), p=0.004); (Hispanic vs NHW 95% CI (1.1-4.3), p=0.02)]. Overall, compared to NHW women, AA women were 3.1 times more likely to have a cancer diagnosis other than breast [95% CI (1.1-8.9), p=0.04] and 5.4 times more likely to suffer from heart failure [95% CI (1.3-23.3), p=0.02]. Compared to NHW women, rates of diabetes were 2.3 times higher among AA women [95% CI (0.95-5.7), p=0.06] and 3.9 times higher among Hispanic women [95% CI (1.4-10.9), p=0.008]. Of the women with a CCI=0 at the time of their BC diagnosis, AA women were 3.3 times more likely [95% CI (1.3-8.1), p=0.01] and Hispanic women were 2.9 times more likely [95% CI (1.0-8.6), p=0.05] to go on to develop at least one chronic condition compared to NHW women. Additionally, of the women who died (n=16), AA and Hispanic women were diagnosed with BC at significantly younger mean ages compared to NHW women [(AA mean age=55 years; Hispanic mean age=64 years; NHW mean age=88 years; p=0.05)]. Conclusion: AA and Hispanic women enter their BC diagnosis with higher mean CCI scores and are more likely to develop ≥1 chronic health condition after their BC diagnosis. Our findings suggest that the burden of chronic disease both before and after BC diagnosis is greater for minority vs. NHW BC survivors. Future studies examining how this impacts survivorship for minority women are warranted. Citation Format: Alpana Kaushiva, Susan Hong. Charlson comorbidity index scores before and after breast cancer diagnosis among a racially diverse cohort of women [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4236.

Sexual functioning among early post-treatment breast cancer survivors.

This study aims (1) to estimate percentages of partnered women who are sexually active over the first 2years post-breast cancer diagnosis; (2) to identify factors related to sexual inactivity; and (3) to evaluate separately, among both sexually active and inactive survivors, the relation between sexual problems and treatment-related variables, symptoms, and psychosocial factors. Longitudinal observational study of breast cancer survivors recruited within 8months of cancer diagnosis and followed for 18months. The main outcome measures were (1) being sexually active/inactive in the past month and (2) sexual problems assessed with the four-item sexual problem domain of the Quality of Life in Adult Cancer Survivors (QLACS) scale. At baseline, 52.4% of women reported being sexually active in the past month. This percentage increased to 60.7% 18months later. In multivariable repeated-measures analyses, age, past chemotherapy, depressive symptoms, and lower perceived attractiveness were related to inactivity. Sexually inactive women reported more problems on the QLACS than sexually active women. In stratified multivariable analyses, depressive symptoms were related to greater sexual problems for both sexually active and inactive women, as was vaginal dryness. Among the sexually active women, younger age at diagnosis, less illness intrusiveness, and lower perceived attractiveness were related to more problems. Research has shown that sexual functioning/sexual health are key aspects of quality of life for many cancer survivors, and are often not addressed by health care providers. Future studies should examine how such topics are handled by clinicians in their interactions with survivors.

Minority stress, psychosocial resources, and psychological distress among sexual minority breast cancer survivors.

Few studies have examined unique factors predicting psychological distress among sexual minority (i.e., lesbian and bisexual) women postbreast cancer diagnosis. The present study assessed the association of minority stress and psychosocial resource factors with depression and anxiety symptoms among sexual minority breast cancer survivors. Two hundred one sexual minority women who had ductal carcinoma in situ or Stage I-IV breast cancer participated in this study through the Love/Avon Army of Women. Self-report questionnaires were used to assess demographic and clinical factors, minority stress factors (discrimination, minority identity development, outness), psychosocial resources (resilience, social support), and psychological distress (anxiety and depression). These factors were included in a structural equation model, testing psychosocial resources as mediators between minority stress and psychological distress. There were no significant differences noted between lesbian and bisexual women. The final structural equation model demonstrated acceptable fit across all sexual minority women, χ2 = 27.83, p > .05; confirmatory fit index = 0.97, root-mean-square error of approximation = 0.04, Tucker-Lewis index = 0.93. The model accounted for significant variance in psychological distress (56%). Examination of indirect effects confirmed that exposure to discrimination was associated with distress via association with resilience. Factors unique to sexual minority populations, such as minority stress, may be associated with higher rates of psychological distress among sexual minority breast cancer survivors. However, presence of psychosocial resources may mediate relationships with distress in this population; enhancement of resilience, in particular, could be an aim of psychological intervention. (PsycINFO Database Record

Characteristics associated with nonadherence to medications for hypertension, diabetes, and dyslipidemia among breast cancer survivors

Comorbidity among breast cancer survivors is prevalent, and adherence to medication management of comorbidities may be important for both chronic disease and cancer-related outcomes. Our objective was to determine characteristics associated with nonadherence to common chronic medications among breast cancer survivors. We conducted a retrospective cohort study of 4216 women in an integrated care system diagnosed with early-stage breast cancer between 1990 and 2008 and alive without recurrence or second primary breast cancer in the second-year following diagnosis. Adherence to antihypertensives, oral diabetes medications, and statins was measured during the second-year post-breast cancer diagnosis using medication possession ratios (MPR). Nonadherence was defined as MPR<0.80. We estimated odds ratios (OR) and 95% confidence intervals (CI) for nonadherence to antihypertensives, oral diabetes medications, and statins by various characteristics using multivariable logistic regression. Among 2308 users of antihypertensives (n=1779), diabetes medications (n=499) and/or statins (n=1072), 37% were nonadherent to antihypertensives; 75% were nonadherent to diabetes medications; 39% were nonadherent to statins. In adjusted models, younger age was associated with nonadherence to all three therapeutic classes. Certain cancer treatments were associated with nonadherence to antihypertensives (radiation: OR 1.21, 95% CI 1.01-1.47; endocrine therapy: OR 1.27, 95% CI 1.03-1.52) and diabetes medications (chemotherapy: OR 1.69, 95% CI 1.17-2.21). Less frequent primary care provider visits were associated with higher odds of nonadherence to antihypertensives (OR 1.70, 95% CI 1.19-2.22); and trends showed higher Charlson comorbidity scores associated with greater adherence to diabetes medications (P<0.001) and statins (P=0.032). Nonadherence to medications is high among breast cancer survivors, particularly diabetes medications, and is associated with cancer treatments and other patient characteristics. Additional research is warranted to understand the needs of cancer patients taking chronic medications and explore patient and provider factors influencing adherence.

Effectiveness of bisphosphonate use and risk of contralateral breast cancer and recurrence in women with early-stage breast cancer treated with tamoxifen

The effectiveness of bisphosphonates (BP) in reducing risk of second breast cancer and recurrence in observational studies has been minimally studied. We examined the association of oral BP use on risk of contralateral breast cancer (CBC) and recurrence in 16,781 women diagnosed with early-stage breast cancer from 1996 to 2007, treated with tamoxifen, and followed through December 31, 2009 at Kaiser Permanente Northern California (KPNC, n=8857) and Southern California (KPSC, n=7924). Sociodemographic, clinical, and pharmacy information were extracted from electronic medical records and cancer registries. CBC was identified from cancer registries, and recurrences from electronic health records and chart reviews. Multivariate Cox regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) treating BP use and hormonal therapy as time-varying variables. After mean 6.4years of follow-up, 494 (3.0%) women developed CBC. BP use post-breast cancer diagnosis (>93% alendronate) ranged from 14.5 to 24.9% at both study sites. Overall, there was no association of BP use with reduced risk of CBC (ever use, HR=0.96; 95% CI 0.67-1.38 and continuous use, HR=1.03; 95% CI 0.88, 1.20). Similar null associations were observed for recurrence (ever use, HR=0.98; 95% CI 0.82, 1.17 and continuous use, HR=1.00; 95% CI 0.92, 1.09). Associations varied somewhat by site yet confidence intervals overlapped. BP use was not associated with reduced risk of recurrence or new primary disease among women diagnosed with early breast cancer and treated with tamoxifen.

Abstract B08: Correlations between weight gain and physical health among African American breast cancer survivors

Abstract Purpose: Weight gain after diagnosis is common among women with breast cancer and may affect physical functioning and recurrence; yet few studies have addressed this problem among African American breast cancer survivors. The purpose of our study was to examine associations between weight gain and physical functioning in a population with disparities in overweight/obesity, health-related quality of life (HR-QoL) and breast cancer recurrence. Procedures: We examined the effects of weight gain in a cohort of 220 African-American women diagnosed with breast cancer. Participants completed a 45-minute assessment tool recording weight and breast cancer history, physical health and general well being. Factorial analysis of variance (ANOVA) was used to assess the association between weight gain (pounds) and HR-QoL. We also determined the moderating effects of demographic variables on post-breast cancer diagnosis weight gain. Results: More than half of the study sample (n=113) gained 10 pounds or more after breast cancer diagnosis. Predictors for weight gain included: 1) breast cancer recurrence-78% (p=0.0067); 2) annual income- from $25,000 to $49,999 55% (p=0.0167); 3) some college education-51% (0.0205), and 4) unmarried 46% (p=0.0007). Participants reporting poorer overall quality of life (p=0.0109), poorer physical health quality of life (p=0.0002), and poorer physical functioning (p=0.0263) were more likely to report weight gain after breast cancer diagnosis than those who reported a better quality of life. Conclusions: These results highlight the importance of weight control for African American women after breast cancer diagnosis. Citation Format: Selina A. Smith, Mechelle D. Claridy, Mary S. Whitehead, Joyce Q. Sheats, Bakak Baban, Wonsuk Yoo, Ruben R. Gonzalez-Perez, Ernest Alema-Mensah. Correlations between weight gain and physical health among African American breast cancer survivors. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B08.

Associations between self-reported post-diagnosis physical activity changes, body weight changes, and psychosocial well-being in breast cancer survivors.

Decreased physical activity and weight gain post-breast cancer diagnosis are associated with negative psychosocial, health, and disease outcomes, but little is known about how these factors interact. The purpose of the present study was to conduct a preliminary examination of the association between post-diagnosis physical activity changes, weight changes, and psychosocial well-being in breast cancer survivors. We examined the association between retrospectively collected, self-reported post-diagnosis changes in physical activity and body weight and post-diagnosis fatigue, anxiety, depression, stress, self-esteem, and health-related quality of life (HRQOL) in breast cancer survivors (N = 1,348) using univariate analyses of covariance with Bonferroni's adjustment. After adjusting for covariates, maintaining and/or increasing physical activity post-diagnosis was significantly (p < 0.05 for all), independently associated with lower fatigue, anxiety, depression and stress and higher physical self-worth, physical, social, emotional, functional and breast cancer specific well-being and overall HRQOL (effect sizes = 0.23 to 0.60). Maintaining and/or losing weight was significantly (p < 0.05), independently associated with lower fatigue and higher physical self-worth, physical and breast cancer-specific well-being, and overall HRQOL (effect sizes = .28 to 0.87). There were no significant interaction effects between physical activity and body weight changes. This study provides preliminary data to suggest that maintaining or increasing physical activity and controlling weight post-diagnosis may be independently, positively associated with psychosocial well-being and HRQOL in breast cancer survivors. In addition, weight management effects may be larger and more outcome-specific while physical activity effects may be more general. Future research is warranted to replicate and confirm these findings.