title: Predictors of long-term outcomes in older breast cancer survivors: perceptions versus patterns of care.
abstract: 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.
authors.affiliation: Department of Oncology, Cancer Control Program, Lombardi Cancer Center, Georgetown University School of Medicine, Washington, DC, USA. mandelbj@georgetown.edu
authors.forename: Jeanne S
authors.initials: JS
authors.lastname: Mandelblatt
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Edge
authors.forename: Neal J
authors.initials: NJ
authors.lastname: Meropol
authors.forename: Ruby
authors.initials: R
authors.lastname: Senie
authors.forename: Theodore
authors.initials: T
authors.lastname: Tsangaris
authors.forename: Luther
authors.initials: L
authors.lastname: Grey
authors.forename: Burt M
authors.initials: BM
authors.lastname: Peterson
authors.forename: Yi-Ting
authors.initials: YT
authors.lastname: Hwang
authors.forename: Jon
authors.initials: J
authors.lastname: Kerner
authors.forename: Jane
authors.initials: J
authors.lastname: Weeks
mesh_terms: 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