title: Risk of decline in upper-body function and symptoms among older breast cancer patients.
abstract: BACKGROUND
  Decline in upper-body function and development of upper-body symptoms are adverse effects of breast cancer therapy and may affect functional independence, particularly among older survivors. The long-term risks and predictors are poorly understood.
  
  
  OBJECTIVE
  To characterize the risk of decline in upper-body function and development of symptoms over 4 years of follow-up.
  
  
  METHODS
  We used a prospective cohort design.
  
  
  METHODS
  Six hundred and forty-four early stage breast cancer patients 65 years old or older at surgery enrolled in Rhode Island, North Carolina, Minnesota, and Los Angeles between 1996 and 1999.
  
  
  METHODS
  Upper-body function and symptoms were self-reported at baseline, 6, 15 months, and annually thereafter to 51 months after surgery.
  
  
  RESULTS
  One half of the participants had a decline in upper-body function and one-quarter developed upper-body symptoms. Breast cancer patients were 5-fold more likely to have a decline in upper-body function over 4 years of follow-up than a similar cohort without breast cancer. Better baseline mental health protected against a decline in upper-body function (odds ratio [OR]=0.93, 95% confidence interval [CI] 0.88 to 0.97 for 8-point higher mental health index). Baseline obesity (OR for body mass index [BMI] > or =30 kg/m2 vs <30 kg/m2=2.5, CI=1.6 to 4.0) and axillary node dissection (OR for axillary dissection vs not=3.9, CI=1.1 to 14) predicted the development of upper-body symptoms.
  
  
  CONCLUSIONS
  Primary care physicians should address upper-body function and symptoms with older breast cancer patients, and inform them that these complications of breast cancer treatment are common.
authors: Department of Medicine, Boston University School of Medicine, Boston, MA, USA.
authors: Jennifer L
authors: JL
authors: Westrup
authors: Timothy L
authors: TL
authors: Lash
authors: Soe Soe
authors: SS
authors: Thwin
authors: Rebecca A
authors: RA
authors: Silliman