title: Quality of life among a population-based cohort of older patients with breast cancer.
abstract: BACKGROUND
  Growing numbers of older women receive adjuvant breast cancer therapies, but little is known about the long-term effects of current therapies upon health-related quality of life outside of clinical trials.
  
  
  METHODS
  A population-based cohort of postmenopausal women with incident breast cancer aged sixty-five and older was identified from Medicare claims from four states and followed over five years. General health-related quality of life (HRQOL) was assessed using the Medical Outcomes Study SF-12 Health Survey, and breast cancer-related HRQOL was assessed using the breast cancer subscale of the functional assessment of cancer therapy (FACT-B BCS). The association of HRQOL with sociodemographic variables, comorbidity, and breast cancer variables (stage, treatments, and treatment sequelae) was examined in longitudinal models.
  
  
  RESULTS
  Among the 3083 older breast cancer survivors, general HRQOL as measured by SF-12 mental and physical component scores was similar to norms for non-cancer populations, and remained stable throughout follow-up. Breast cancer treatments, including surgery and radiation, adjuvant hormonal therapy, and cytotoxic chemotherapy were not associated with worsened general health scores. A similar pattern was seen for breast cancer-related HRQOL scores, except that chemotherapy was associated with slightly worse scores. Lymphedema occurred in 17% of the cohort, and was strongly associated with all measures of HRQOL. Reductions in general HRQOL with lymphedema development were larger than those with an age increase of 10 years.
  
  
  CONCLUSIONS
  There is little association of breast cancer treatment with HRQOL in older breast cancer patients followed for up to five years, but the development of lymphedema is associated with substantial reductions in HRQOL.
authors.affiliation: Medical College of Wisconsin, Department of Medicine, 9200 W Wisconsin Avenue, Milwaukee, WI 53226, USA; Center for Patient Care and Outcomes Research, 8701 Watertown Plank Road, Suite H3100, Milwaukee, WI 53226, USA. Electronic address: jneuner@mcw.edu.
authors.forename: Joan M
authors.initials: JM
authors.lastname: Neuner
authors.affiliation: Center for Patient Care and Outcomes Research, 8701 Watertown Plank Road, Suite H3100, Milwaukee, WI 53226, USA.
authors.forename: Nathan
authors.initials: N
authors.lastname: Zokoe
authors.affiliation: Center for Patient Care and Outcomes Research, 8701 Watertown Plank Road, Suite H3100, Milwaukee, WI 53226, USA.
authors.forename: Emily L
authors.initials: EL
authors.lastname: McGinley
authors.affiliation: Medical College of Wisconsin, Department of Medicine, 9200 W Wisconsin Avenue, Milwaukee, WI 53226, USA; Center for Patient Care and Outcomes Research, 8701 Watertown Plank Road, Suite H3100, Milwaukee, WI 53226, USA.
authors.forename: Liliana E
authors.initials: LE
authors.lastname: Pezzin
authors.affiliation: Medical College of Wisconsin, Department of Surgical Oncology, 9200 W Wisconsin Avenue, Milwaukee, WI 53226, USA; Center for Patient Care and Outcomes Research, 8701 Watertown Plank Road, Suite H3100, Milwaukee, WI 53226, USA.
authors.forename: Tina W F
authors.initials: TW
authors.lastname: Yen
authors.affiliation: Perelman School of Medicine at the University of Pennsylvania, 295 John Morgan Building, 3620 Hamilton Walk, Philadelphia, PA 19104, USA.
authors.forename: Marilyn M
authors.initials: MM
authors.lastname: Schapira
authors.affiliation: Medical College of Wisconsin, Department of Medicine, 9200 W Wisconsin Avenue, Milwaukee, WI 53226, USA; Center for Patient Care and Outcomes Research, 8701 Watertown Plank Road, Suite H3100, Milwaukee, WI 53226, USA.
authors.forename: Ann B
authors.initials: AB
authors.lastname: Nattinger
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000150:complications / Q000523:psychology* / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D008209:Lymphedema / Q000209:etiology / Q000523:psychology; D015233:Models, Statistical; D011788:Quality of Life; D011795:Surveys and Questionnaires; D014481:United States
keywords: Adjuvant hormonal therapy; Breast cancer; Lymphedema; Population research; Quality of life