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Breast Cancer in Older Women: Quality of Life and Psychosocial Adjustment in the 15 Months After Diagnosis

Patricia A. Ganz, Edward Guadagnoli, Mary Beth Landrum, Timothy L. Lash, William Rakowski, Rebecca A. Silliman

From the University of California, Los Angeles, Schools of Medicine and Public Health and the Jonsson Comprehensive Cancer Center, Los Angeles, CA; Department of Health Care Policy, Harvard Medical School; Department of Epidemiology, Boston University School of Public Health; Department of Medicine, Boston University School of Medicine, Boston, MA; and Department of Community Health, Brown University, Providence, RI.

Address reprint requests to Patricia A. Ganz, MD, Division of Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center, 650 Charles Young Drive South, Los Angeles, CA 90095-6900; e-mail: pganz{at}ucla.edu.

Purpose: We examined the health-related quality of life (QOL) of a cohort of older women with breast cancer after their diagnosis.

Patients and Methods: Six hundred ninety-one women aged 65 years and older were interviewed approximately 3 months after breast cancer surgery and two additional times in the following year using standardized QOL measures. Demographic factors, breast cancer treatments, and comorbid conditions were used to model ratings of health-related QOL over time. Self-perceived health and psychosocial adjustment at 15 months after surgery were modeled.

Results: Physical and mental health scores declined significantly in the follow-up year, independent of age. However, a cancer-specific psychosocial instrument showed significant improvement in scores. Better 3-month physical and mental health scores, as well as better emotional social support, predicted more favorable self-perceived health 15 months after surgery. Psychosocial adjustment at 15 months was significantly predicted by better mental health, emotional social support, and better self-rated interaction with health care providers assessed at 3 months.

Conclusion: Contrary to reports from younger women with breast cancer, we observed significant declines in the physical and mental health of older women in the 15 months after breast cancer surgery, whereas scores on a cancer-specific psychosocial QOL measure improved over time, consistent with patterns in younger women. Predictive models indicate that older women with impaired physical functioning, mental health, and emotional social support after surgery have poorer self-perceived health and psychosocial adjustment 1 year later. Interventions to address the physical and emotional needs of older women with breast cancer should be developed and evaluated to determine their impact on subsequent health-related QOL.

Supported by grant no. CA/AG 70818 from the National Institutes of Health/National Cancer Institute (Bethesda, MD) and an American Cancer Society Clinical Research Professorship Award (P.A.G.).

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