Impact of Breast Cancer on Older Survivors

描述（由申请人提供）： 美国最近和预期的人口变化扩大了癌症幸存者在≥ 65岁人群中的集中程度。目前，在估计的890万癌症幸存者中，60%的人年龄在65岁以上，预计在未来30年内，这一年龄组的发病病例数将翻一番。这些总体趋势反映在乳腺癌的具体案例中。据估计，2002年有203 500名妇女被诊断患有乳腺癌，其中近一半的病例发生在65岁以上的妇女中。这一比例和相应的绝对数字可能会增加，因为年龄较大是乳腺癌最重要的风险因素，而且预期寿命的延长将导致更多妇女在更长的时间内处于风险之中。对于这些老年妇女，乳腺癌及其治疗的后果可能是复杂的，由于乳腺癌治疗后遗症，非乳腺癌合并症和年龄相关的残疾的相互作用。我们正在对900多名65岁及以上的中度和高度乳腺癌复发风险的女性进行多中心研究。我们建议在诊断后平均随访该队列10年，以检查乳腺癌及其治疗，年龄相关的合并症和功能障碍以及长期老年乳腺癌幸存者的健康结果之间的关系。利用我们自诊断以来一直跟踪的这一仔细和全面研究的女性队列，并辅以医疗保险索赔数据，我们将：（1）描述乳腺癌复发监测的模式，并评估指南监测对乳腺癌死亡率、全因死亡率和健康相关生活质量（HRQOL）的影响;（2）确定与HRQOL（特别是心理社会和身体功能）方面成功和不成功生存相关的人口统计学、治疗和肿瘤特征;和（3）确定乳腺癌诊断对总合并症负担和非乳腺癌护理质量的影响。拟议项目的结果将提供关于大量和越来越多的老年妇女长期幸存的乳腺癌的新信息。了解他们的身体，心理，医疗和肿瘤护理需求将告知未来的护理老年妇女与这种疾病。

DESCRIPTION (provided by applicant): Recent and anticipated demographic changes in the United States have magnified the concentration of cancer survivors among persons >=65 years of age. At present 60% of the estimated 8.9 million cancer survivors are >=65 years of age and the number of incident cases in this age group is expected to double over the next 30 years. These overall trends are reflected in the specific case of breast cancer. An estimated 203,500 women were diagnosed with breast cancer in 2002, with almost half of the cases occurring in women >=65 years of age. This proportion and the corresponding absolute numbers are likely to grow, because older age is the most important risk factor for breast cancer and because gains in life expectancy will result in more women being at risk for longer periods of time. For these older women, the consequences of breast cancer and its treatment are likely to be complex, due to the interaction of breast cancer treatment sequelae, non-breast cancer comorbidities, and age-related disabilities. We are conducting a multi-site study of over 900 women 65 years of age and older at intermediate and high risk of breast cancer recurrence. We propose to follow this cohort for an average of 10 years following diagnosis to examine the relationships among breast cancer and its treatment, age-related comorbidities and functional impairments, and health outcomes in long-term older breast cancer survivors. Taking advantage of this carefully and comprehensively studied cohort of women whom we have followed since diagnosis, and complemented by Medicare claims data, we will: (1) describe patterns of breast cancer recurrence surveillance and assess the impact of guideline surveillance on breast cancer mortality, all-cause mortality, and health-related quality of life (HRQOL); (2) identify demographic, treatment, and tumor characteristics associated with successful and unsuccessful survivorship with respect to HRQOL, specifically psychosocial and physical function; and (3) determine the impact of a breast cancer diagnosis on total comorbidity burden and quality of non-breast cancer care. Results from the proposed project will provide new information about the large and growing number of older women who are long-term survivors of breast cancer. Understanding their physical, psychological, and medical and oncological care needs will inform the future care of older women with this disease.