title: Increasing our understanding of dying of breast cancer: Comorbidities and care.
abstract: Background: Screening and treatment for breast cancer have improved. However, attention to palliative support and non-cancer co-morbidities has been limited. This study identified types of care for and co-morbidities of persons dying of breast cancer compared to persons dying from all cancers and from non-cancer causes.Methods: Linked administrative data from population-based registries were used to examine 121,458 deaths in Nova Scotia from 1995 to 2009.Results: Breast cancer decedents' mean age was similar to that of all cancer decedents (72.0 versus 72.1 years), but their age spread was greater (20-59 years: 23.1% versus 16.7%; 90+ years: 11.2% versus 6.5%). Among women dying of breast cancer, 15.6% were enrolled in the diabetes registry and 15.1% in the cardiovascular registry, indicating that they had these non-cancer conditions prior to their death. Compared to all cancer decedents, breast cancer decedents were twice as likely to have dementia as a cause of death, and were less likely to die in hospital but more likely to die in a nursing home. Breast cancer decedents had place of death rates more similar to non-cancer than cancer decedents.Conclusions: Rates of dementia and diabetes among the breast cancer decedents were particularly note-worthy in this novel study given that these comorbidities have not received much attention in the breast cancer research literature. Further collaboration with non-cancer disease programs is advised. The extent of adequate comprehensive palliative support for the 20% of the breast cancer decedents who are nursing home residents requires investigation.
authors.affiliation: School of Health Administration, Dalhousie University, Halifax, Canada; Surveillance and Epidemiology Unit, Cancer Care Nova Scotia, Halifax, Canada.
authors.forename: G M
authors.identifier: 0000-0001-8201-629X
authors.initials: GM
authors.lastname: Johnston
authors.affiliation: Department of Surgery, Dalhousie University, Halifax, Canada; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Urquhart
authors.affiliation: School of Health Administration, Dalhousie University, Halifax, Canada; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Lethbridge
authors.affiliation: Surveillance and Epidemiology Unit, Cancer Care Nova Scotia , Halifax , Canada.
authors.forename: M
authors.initials: M
authors.lastname: MacIntyre
keywords: Breast cancer; Cardiovascular disease; Dementia; Diabetes; Mortality; Nursing home; Survivor: Palliative