Comprehensive evaluation of the incidence of late effects in 5-year survivors of breast cancer

Abstract

Purpose Late effects of breast cancer affect the quality of survivorship. Using administrative data, we compared the occurrence of almost all ICD9 codes among older breast cancer survivors to that among a matched comparison cohort to generate new hypotheses. Methods Breast cancer patients sixty-five years or older diagnosed 1990–1994 in six integrated care settings and who survived at least five years were matched with a cohort of women without a history of breast cancer on care setting, age, and calendar time. We collected data on the occurrence of incident ICD9 codes beginning six years after the breast cancer diagnosis date and continuing to year fifteen, and comparable data for the matched woman. We calculated hazard ratios and 95% confidence intervals associating breast cancer survivorship with incidence of each ICD9 code. We used semi-Bayes methods to address multiple comparisons. Results Older breast cancer survivors had about the same occurrence of diseases and conditions six to fifteen years after breast cancer diagnosis as comparable women. The median of 564 adjusted hazard ratios equaled 1.06, with interquartile range 0.92 to 1.3. The distribution of hazard ratios pertaining to cancer-related ICD codes was shifted towards positive associations, and the distribution pertaining to cardiovascular-related ICD codes was shifted towards negative associations. Conclusions In this hypothesis scanning study, we observed little difference in the occurrence of non-breast cancer-related diseases and conditions among older, long-term breast cancer survivors and comparable women without a history of breast cancer.

Relative mortality rates from incident chronic diseases among breast cancer survivors – A 14year follow-up of five-year survivors diagnosed in Denmark between 1994 and 2007

“…Younger patients and patients with localised or regional stage breast cancer had higher relative mortality than older patients and patients with distant or unknown spread breast cancer, likely due to modification of the relative rates by the higher baseline mortality rates among older patients and patients with distant and unknown stage breast cancer. Previous investigations demonstrated that five-year breast cancer survivors have a similar frequency of prevalent and incident diseases as women from the general population, in agreement with our study [7,[12][13][14]32]. This similarity is supported by a recent study suggesting that conventional risk factors, such as smoking, diabetes and hypertension are associated with incident cardiovascular conditions in five-year breast cancer survivors rather than a diagnosis of breast cancer as compared with women from the general population [33].…”

“…Patients with comorbidity potentially receive a modified course of treatment and have poorer survival than otherwise healthy breast cancer patients [4][5][6][9][10][11][12]. Recent studies from the United States documented that older five-year breast cancer survivors have approximately similar incidence of new medical conditions as agematched women from the general population [13][14][15]. Incident diseases were associated with seven-fold increased mortality among women from the general population but only four-fold among the breast cancer survivors [13].…”

Metastatic Breast Cancer Collateral Damage Project (MBCCD): Scale development and preliminary results of the Survey of Health, Impact, Needs, and Experiences (SHINE)

“…Adverse symptoms and complications, termed late effects , can arise from breast cancer and its treatments long after diagnosis [9]. Research on late effects predominantly focuses on biomedical sequelae [10]; long-lasting changes in other aspects (e.g., psychological, social, vocational, financial, functional) of patients’ lives—a concept we call collateral damage [11, 12] requires study. Characterizing MBC-specific collateral damage is important to better understand and improve the lives of people with MBC, as was the primary goal of the present study.…”

Long-term cardiac composite risk following adjuvant treatment in breast cancer patients

“…In a study conducted in a long-term survivor cohort and cancer-free controls, there was no difference in newly diagnosed diseases [22] in over 10 years of follow-up. There were even slight shifts to the left for circulatory diseases.…”