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Predictors of Long-Term Outcomes in Older Breast Cancer Survivors: Perceptions Versus Patterns of Care

Jeanne S. Mandelblatt, Stephen B. Edge, Neal J. Meropol, Ruby Senie, Theodore Tsangaris, Luther Grey, Burt M. Peterson, Jr, Yi-Ting Hwang, Jon Kerner, Jane Weeks

From the Department of Oncology, Cancer Control Program, Lombardi Cancer Center, and Department of Surgery, Georgetown University School of Medicine; Department of Surgery, Sibley Memorial Hospital, Washington, DC; Department of Epidemiology, Mailman School of Public Health of Columbia University, and Department of Surgery, Beth Israel Medical Center, New York; Department of Surgery, Roswell Park Cancer Institute, State University of New York at Buffalo, Buffalo, NY; Divisions of Medical Science and Population Science, Fox Chase Cancer Center, Philadelphia, PA; National Cancer Institute, Bethesda, MD; and Department of Medicine, Dana-Farber Cancer Institute, Boston, MA.

Address reprint requests to Jeanne Mandelblatt, MD, Lombardi Cancer Center, 2233 Wisconsin Ave, Suite 317, Washington, DC 20007; email: mandelbj{at}georgetown.edu.

Purpose: There are few data on sequelae of breast cancer treatments in older women. We evaluated posttreatment quality of life and satisfaction in a national population.

Patients and Methods: Telephone surveys were conducted with a random cross-sectional sample of 1,812 Medicare beneficiaries 67 years of age and older who were 3, 4, and 5 years posttreatment for stage I and II breast cancer. Regression models were used to estimate the adjusted risk of decrements in physical and mental health functioning by treatment. In a subset of women (n = 732), additional data were used to examine arm problems, impact of cancer, and satisfaction, controlling for baseline health, perceptions of ageism and racism, demographic and clinical factors, region, and surgery year.

Results: Use of axillary dissection was the only surgical treatment that affected outcomes, increasing the risk of arm problems four-fold (95% confidence interval, 1.56 to 10.51), controlling for other factors. Having arm problems, in turn, exerted a consistently negative independent effect on all outcomes (P .001). Processes of care were also associated with quality of life and satisfaction. For example, women who perceived high levels of ageism or felt that they had no choice of treatment reported significantly more bodily pain, lower mental health scores, and less general satisfaction. These same factors, as well as high perceived racism, were significantly associated with diminished satisfaction with the medical care system.

Conclusion: With the exception of axillary dissection, the processes of care, and not the therapy itself, are the most important determinants of long-term quality of life in older women.

Supported by grant no. RO1 HS 08395 from the Agency for Health Care Policy and Research, Bethesda, MD, and grant no. DAMD17-94-J-4212 from the Department of the Army, Washington, DC.

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