Jingjing Zhu1, Fei Wang1,2, Liang Shi3, Hui Cai1, Ying Zheng4,5, Wei Zheng1, Pingping Bao3, Xiao-Ou Shu6. 1. Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 600 (IMPH), Nashville, TN, USA. 2. Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, Shandong, People's Republic of China. 3. Department of Chronic Non-Communicable Disease Surveillance, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China. 4. Department of Cancer Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China. 5. Department of Cancer Prevention, Shanghai Cancer Center, Fudan University, Shanghai, People's Republic of China. 6. Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 600 (IMPH), Nashville, TN, USA. xiao-ou.shu@vanderbilt.edu.
Abstract
PURPOSE: To prospectively investigate accelerated aging and its association with total mortality and breast cancer-specific mortality/recurrence among breast cancer survivors. METHODS: This study included 4218 female breast cancer patients enrolled into a population-based cohort study approximately 6-month post-diagnosis. Information on aging-related symptoms (i.e., self-rated overall health condition, energy level, depression, sleep difficulty, and quality) was collected at 18- and 36-month post-diagnosis surveys. Information on overall health, daily function impairments, survival status, and recurrence was collected at 10-year post-diagnosis survey. Record linkages with vital statistics were conducted to collect mortality information. Cox proportional hazards model was applied. RESULTS: Among 3041 10-year survivors with a mean age of 63.7 ± 9.7 years, respectively, 52.3%, 19.0%, and 27.6% reported poor health, limitation in daily activity, and climbing floors. Age-specific prevalence revealed that breast cancer survivors reached similar prevalence of the functional limitations 5-10 years earlier than cancer-free women. At the 18-month post-diagnosis survey, respectively, 47.0%, 72.5%, and 25.1% of survivors reported unsatisfied overall health condition, reduced energy level, and depression symptoms. After a median follow-up of 10.9 years, low self-rated overall health, low energy level, and depression were significantly associated with increased total mortality, with hazard ratios (HRs; 95% confidence intervals [CI]) of 3.14 (2.43, 4.06), 1.49 (1.20, 1.84), and 1.59 (1.21, 2.09), respectively. Low self-rated health was associated with breast cancer-specific mortality/recurrence (HR 1.85, 95% CI 1.30, 2.65). No significant association was found for sleep difficulty and quality. CONCLUSION: Aging-related physical changes/symptoms are commonly presented at 18 months after breast cancer diagnosis and are associated with worse prognosis. IMPACT: Our findings highlight the concern of accelerated aging among breast cancer survivors.
PURPOSE: To prospectively investigate accelerated aging and its association with total mortality and breast cancer-specific mortality/recurrence among breast cancer survivors. METHODS: This study included 4218 female breast cancer patients enrolled into a population-based cohort study approximately 6-month post-diagnosis. Information on aging-related symptoms (i.e., self-rated overall health condition, energy level, depression, sleep difficulty, and quality) was collected at 18- and 36-month post-diagnosis surveys. Information on overall health, daily function impairments, survival status, and recurrence was collected at 10-year post-diagnosis survey. Record linkages with vital statistics were conducted to collect mortality information. Cox proportional hazards model was applied. RESULTS: Among 3041 10-year survivors with a mean age of 63.7 ± 9.7 years, respectively, 52.3%, 19.0%, and 27.6% reported poor health, limitation in daily activity, and climbing floors. Age-specific prevalence revealed that breast cancer survivors reached similar prevalence of the functional limitations 5-10 years earlier than cancer-free women. At the 18-month post-diagnosis survey, respectively, 47.0%, 72.5%, and 25.1% of survivors reported unsatisfied overall health condition, reduced energy level, and depression symptoms. After a median follow-up of 10.9 years, low self-rated overall health, low energy level, and depression were significantly associated with increased total mortality, with hazard ratios (HRs; 95% confidence intervals [CI]) of 3.14 (2.43, 4.06), 1.49 (1.20, 1.84), and 1.59 (1.21, 2.09), respectively. Low self-rated health was associated with breast cancer-specific mortality/recurrence (HR 1.85, 95% CI 1.30, 2.65). No significant association was found for sleep difficulty and quality. CONCLUSION: Aging-related physical changes/symptoms are commonly presented at 18 months after breast cancer diagnosis and are associated with worse prognosis. IMPACT: Our findings highlight the concern of accelerated aging among breast cancer survivors.
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