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Long-term prognostic role of functional limitations among women with breast cancer.
J Natl Cancer Inst. 2010 Oct 06; 102(19):1468-77.JNCI

Abstract

BACKGROUND

The long-term prognostic role of functional limitations among women with breast cancer is poorly understood.

METHODS

We studied a cohort of 2202 women with breast cancer at two sites in the United States, who provided complete information on body functions involving endurance, strength, muscular range of motion, and small muscle dexterity following initial adjuvant treatment. Associations of baseline functional limitations with survival were evaluated in delayed entry Cox proportional hazards models, with adjustment for baseline sociodemographic factors, body mass index, smoking, physical activity, comorbidity, tumor characteristics, and treatment. Difference in covariates between women with and without limitations was assessed with Pearson χ(2) and Student t tests. All statistical tests were two-sided.

RESULTS

During the median follow-up of 9 years, 112 deaths were attributable to competing causes (5% of the cohort) and 157 were attributable to breast cancer causes (7% of the cohort). At least one functional limitation was present in 39% of study participants. Proportionately, more breast cancer patients with functional limitations after initial adjuvant treatment were older, less educated, and obese (P < .001). In multivariable models, functional limitations were associated with a statistically significantly increased risk of death from all causes (hazard ratio [HR] = 1.40, 95% confidence interval [CI] = 1.03 to 1.92) and from competing causes (HR = 2.60, 95% CI = 1.69 to 3.98) but not from breast cancer (HR = 0.90, 95% CI = 0.64 to 1.26). The relationship between functional limitations and overall survival differed by tumor stage (among women with stage I and stage III breast cancer, HR = 2.02, 95% CI = 1.23 to 3.32 and HR = 0.74, 95% CI = 0.42 to 1.30, respectively).

CONCLUSION

In this prospective cohort study, functional limitations following initial breast cancer treatment were associated with an important reduction in all-cause and competing-cause survival, irrespective of clinical, lifestyle, and sociodemographic factors.

Authors+Show Affiliations

Helen Diller Family Comprehensive Cancer Center and the Department of Epidemiology and Biostatistics, University of California, San Francisco, 185 Berry St, Ste 5700, San Francisco, CA 94107, USA. dbraithwaite@epi.ucsf.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20861456

Citation

Braithwaite, Dejana, et al. "Long-term Prognostic Role of Functional Limitations Among Women With Breast Cancer." Journal of the National Cancer Institute, vol. 102, no. 19, 2010, pp. 1468-77.
Braithwaite D, Satariano WA, Sternfeld B, et al. Long-term prognostic role of functional limitations among women with breast cancer. J Natl Cancer Inst. 2010;102(19):1468-77.
Braithwaite, D., Satariano, W. A., Sternfeld, B., Hiatt, R. A., Ganz, P. A., Kerlikowske, K., Moore, D. H., Slattery, M. L., Tammemagi, M., Castillo, A., Melisko, M., Esserman, L., Weltzien, E. K., & Caan, B. J. (2010). Long-term prognostic role of functional limitations among women with breast cancer. Journal of the National Cancer Institute, 102(19), 1468-77. https://doi.org/10.1093/jnci/djq344
Braithwaite D, et al. Long-term Prognostic Role of Functional Limitations Among Women With Breast Cancer. J Natl Cancer Inst. 2010 Oct 6;102(19):1468-77. PubMed PMID: 20861456.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term prognostic role of functional limitations among women with breast cancer. AU - Braithwaite,Dejana, AU - Satariano,William A, AU - Sternfeld,Barbara, AU - Hiatt,Robert A, AU - Ganz,Patricia A, AU - Kerlikowske,Karla, AU - Moore,Dan H, AU - Slattery,Martha L, AU - Tammemagi,Martin, AU - Castillo,Adrienne, AU - Melisko,Michelle, AU - Esserman,Laura, AU - Weltzien,Erin K, AU - Caan,Bette J, Y1 - 2010/09/22/ PY - 2010/9/24/entrez PY - 2010/9/24/pubmed PY - 2010/10/21/medline SP - 1468 EP - 77 JF - Journal of the National Cancer Institute JO - J. Natl. Cancer Inst. VL - 102 IS - 19 N2 - BACKGROUND: The long-term prognostic role of functional limitations among women with breast cancer is poorly understood. METHODS: We studied a cohort of 2202 women with breast cancer at two sites in the United States, who provided complete information on body functions involving endurance, strength, muscular range of motion, and small muscle dexterity following initial adjuvant treatment. Associations of baseline functional limitations with survival were evaluated in delayed entry Cox proportional hazards models, with adjustment for baseline sociodemographic factors, body mass index, smoking, physical activity, comorbidity, tumor characteristics, and treatment. Difference in covariates between women with and without limitations was assessed with Pearson χ(2) and Student t tests. All statistical tests were two-sided. RESULTS: During the median follow-up of 9 years, 112 deaths were attributable to competing causes (5% of the cohort) and 157 were attributable to breast cancer causes (7% of the cohort). At least one functional limitation was present in 39% of study participants. Proportionately, more breast cancer patients with functional limitations after initial adjuvant treatment were older, less educated, and obese (P < .001). In multivariable models, functional limitations were associated with a statistically significantly increased risk of death from all causes (hazard ratio [HR] = 1.40, 95% confidence interval [CI] = 1.03 to 1.92) and from competing causes (HR = 2.60, 95% CI = 1.69 to 3.98) but not from breast cancer (HR = 0.90, 95% CI = 0.64 to 1.26). The relationship between functional limitations and overall survival differed by tumor stage (among women with stage I and stage III breast cancer, HR = 2.02, 95% CI = 1.23 to 3.32 and HR = 0.74, 95% CI = 0.42 to 1.30, respectively). CONCLUSION: In this prospective cohort study, functional limitations following initial breast cancer treatment were associated with an important reduction in all-cause and competing-cause survival, irrespective of clinical, lifestyle, and sociodemographic factors. SN - 1460-2105 UR - https://www.unboundmedicine.com/medline/citation/20861456/Long_term_prognostic_role_of_functional_limitations_among_women_with_breast_cancer_ L2 - https://academic.oup.com/jnci/article-lookup/doi/10.1093/jnci/djq344 DB - PRIME DP - Unbound Medicine ER -