The persistent impact of breast carcinoma on functional health status: prospective evidence from the Nurses' Health Study.
BACKGROUND
Although physical and emotional function after the diagnosis of breast carcinoma have been described in clinic populations, to the authors' knowledge no previous study has measured change from the preillness level of functional health status in community-dwelling women.


METHODS
The authors conducted a 4-year (1992-96) prospective study of functional recovery after breast carcinoma in a large sample of women, aged 54-73 years. They collected multidimensional measures of self-reported functional health status in 1992, before diagnosis of breast carcinoma, and again in 1996, to examine the risk of decline associated with incident breast carcinoma.


RESULTS
After adjustment for age, baseline functional health status, and multiple covariates, women who developed incident breast carcinoma were more likely to have experienced reduced physical function, role function, vitality, and social function and increased bodily pain compared with women who remained free of breast carcinoma. Risk of decline was attenuated with increasing time since diagnosis. Risk of decline in physical function was evident across all stages of breast carcinoma, even after adjustment for women undergoing treatment for persistent or recurrent disease. We found evidence that the risk of decline among breast carcinoma cases compared with healthy women was largest among those who were most socially isolated.


CONCLUSIONS
Breast carcinoma results in persistent declines in multiple dimensions of functional health status. These prospective data suggest that previous studies reporting no difference in physical function among breast carcinoma cases compared with disease free women underestimated the deleterious effect of the disease on function. Socially isolated women are an especially vulnerable group.
Michael
Y L
YL
School of Community Health, College of Urban and Public Affairs, Portland State University, Oregon, USA.
Kawachi
I
I
Berkman
L F
LF
Holmes
M D
MD
Colditz
G A
GA
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000503:physiopathology* / Q000523:psychology; D005260:Female; D006304:Health Status; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors; D012944:Social Support