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The association between physical health-related quality of life, physical functioning, and risk of contralateral breast cancer among older women

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Abstract

Background

Physical limitations prior to cancer diagnosis may lead to suboptimal health outcomes. Our objective was to evaluate the impacts of poor physical health-related quality of life (HRQOL) and physical functioning (PF) on the risk of contralateral breast cancer (CBC).

Methods

We performed a nested case–control study of women with invasive unilateral breast cancer (UBC) who did not receive prophylactic contralateral mastectomy using the Surveillance, Epidemiology and End Results Medicare Health Outcomes Survey data resource. Among 2938 women aged ≥ 65 years diagnosed with first stage I–III UBC between 1997 and 2011, we identified 100 subsequent CBC cases and 915 matched controls without CBC using incidence density sampling without replacement. Pre-diagnosis physical HRQOL and PF were determined using Medical Outcomes Trust Short Form-36 (SF-36)/Veterans Rand 12-Item Health Survey (VR-12) responses within 2 years prior to first UBC diagnosis. We estimated adjusted odds ratios (OR) and 95% confidence intervals (CI) using conditional logistic regression models.

Results

Cases and controls were similar with respect to comorbidities, stage, surgery, and radiation treatments, but differed by hormone receptor status (ER/PR-negative, 23% and 11%, respectively) of first UBC. Cases had modestly lower mean pre-diagnosis physical HRQOL (− 1.8) and PF (− 2.2) scores. In multivariable models, we observed an increased CBC risk associated with low physical HRQOL (lowest vs. highest quartile, OR = 1.8; 95% CI 0.8–4.3), but CIs included 1.0. Low PF was associated with a 2.7-fold (95% CI 1.1–6.7) increased CBC risk.

Conclusions

Findings indicate that low physical HRQOL, specifically poor PF, is associated with CBC risk. Efforts to understand and minimize declines in PF post-breast cancer are well motivated.

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Acknowledgements

This study used data from the Surveillance, Epidemiology, and End Results (SEER)—Medicare Health Outcomes Survey (MHOS) linked data resource. The authors acknowledge the role of the National Cancer Institute; the Centers for Medicare and Medicaid Services; MHOS; Information Management Services, Inc; and the SEER Program tumor registries in the creation of the SEER-MHOS database. The National Cancer Institute provided suggested edits and approval of the manuscript before final journal submission.

Funding

NHM was supported by the University of Illinois Cancer Center Pfizer Fellowship. Research reported in this publication was supported, in part, by the National Institutes of Health’s National Cancer Institute, Grant Numbers U54CA202995, U54CA202997, and U54CA203000. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Author notes

  1. Colin C. Hubbard

    Present address: Department of Medicine, University of California San Francisco, San Francisco, CA, USA

Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA

    Nita H. Mukand

  2. School of Medicine, Section of Hematology Oncology, Boston University, Boston, MA, USA

    Naomi Y. Ko

  3. Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, 833 South Wood Street MC 871, Chicago, IL, 60612<, USA

    Nadia A. Nabulsi, Colin C. Hubbard & Gregory S. Calip

  4. Department of Public Health Sciences, The University of Chicago, Chicago, IL, USA

    Brian C.-H. Chiu

  5. Division of Hematology and Oncology, University of Illinois at Chicago, Chicago, IL, USA

    Kent F. Hoskins

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Correspondence to Gregory S. Calip.

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Conflict of interest

Dr. Calip reports current employment with Flatiron Health, Inc., which is an independent subsidiary of the Roche group; stock ownership in Roche; and research funding from Pfizer, Inc. unrelated to this study awarded to the University of Illinois at Chicago.

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Mukand, N.H., Ko, N.Y., Nabulsi, N.A. et al. The association between physical health-related quality of life, physical functioning, and risk of contralateral breast cancer among older women. Breast Cancer 29, 287–295 (2022). https://doi.org/10.1007/s12282-021-01309-x

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