Predictors of long-term outcomes in older breast cancer survivors: perceptions versus patterns of care.
OBJECTIVE
There are few data on sequelae of breast cancer treatments in older women. We evaluated posttreatment quality of life and satisfaction in a national population.


METHODS
Telephone surveys were conducted with a random cross-sectional sample of 1,812 Medicare beneficiaries 67 years of age and older who were 3, 4, and 5 years posttreatment for stage I and II breast cancer. Regression models were used to estimate the adjusted risk of decrements in physical and mental health functioning by treatment. In a subset of women (n = 732), additional data were used to examine arm problems, impact of cancer, and satisfaction, controlling for baseline health, perceptions of ageism and racism, demographic and clinical factors, region, and surgery year.


RESULTS
Use of axillary dissection was the only surgical treatment that affected outcomes, increasing the risk of arm problems four-fold (95% confidence interval, 1.56 to 10.51), controlling for other factors. Having arm problems, in turn, exerted a consistently negative independent effect on all outcomes (P </=.001). Processes of care were also associated with quality of life and satisfaction. For example, women who perceived high levels of ageism or felt that they had no choice of treatment reported significantly more bodily pain, lower mental health scores, and less general satisfaction. These same factors, as well as high perceived racism, were significantly associated with diminished satisfaction with the medical care system.


CONCLUSIONS
With the exception of axillary dissection, the processes of care, and not the therapy itself, are the most important determinants of long-term quality of life in older women.
Mandelblatt
Jeanne S
JS
Department of Oncology, Cancer Control Program, Lombardi Cancer Center, Georgetown University School of Medicine, Washington, DC, USA. mandelbj@georgetown.edu
Edge
Stephen B
SB
Meropol
Neal J
NJ
Senie
Ruby
R
Tsangaris
Theodore
T
Grey
Luther
L
Peterson
Burt M
BM
Hwang
Yi-Ting
YT
Kerner
Jon
J
Weeks
Jane
J
D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology / Q000523:psychology* / Q000628:therapy*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007407:Interviews as Topic; D008197:Lymph Node Excision; D006278:Medicare / Q000706:statistics & numerical data; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D017060:Patient Satisfaction; D010465:Perception; D011237:Predictive Value of Tests; D011379:Prognosis; D011787:Quality of Health Care; D011788:Quality of Life; D017741:Survivors