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The impact of functional limitations on long-term outcomes among African-American and white women with breast cancer: a cohort study
  1. Monika Izano1,
  2. William A Satariano2,
  3. Robert A Hiatt1,3,
  4. Dejana Braithwaite1,3
  1. 1Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
  2. 2School of Public Health, University of California, Berkeley, California, USA
  3. 3Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California, USA
  1. Correspondence to Dr Dejana Braithwaite; DBraithwaite{at}epi.ucsf.edu

Abstract

Objectives We examined the impact of functional limitations and functional decline during the first year following breast cancer diagnosis on the risk of mortality from breast cancer and other causes among African-American and white women, respectively.

Design The Health and Functioning in Women (HFW) cohort study.

Setting Detroit, Michigan, USA.

Participants A total of 162 African-American and 813 white women aged 40–84 years with newly diagnosed breast cancer identified through the Metropolitan Detroit Cancer Surveillance System over a 7-month period between 1984 and 1985 and followed for up to 28 years (median 11 years).

Outcome measures Risk of mortality from breast cancer and other causes.

Results Statistically significant increases in the risk of other-cause mortality were found for each unit increase in the number of self-reported functional limitations (HR=1.08, 95% CI 1.03 to 1.14), 0 vs ≥1 functional limitations (HR=1.47, 95% CI 1.13 to 1.91), difficulty in pushing or pulling large objects (HR=1.34, 95% CI 1.04 to 1.73), writing or handling small objects (HR=1.56, 95% CI 1.00 to 2.44), and walking half a mile (HR=1.60, 95% CI 1.19 to 2.14). Functional limitations and functional decline did not explain racial disparities in the survival of this cohort. Functional decline was associated with increased risk of other-cause mortality in women with regional and remote disease but not in women with localised disease. Whereas measures of functional limitation were not associated with breast cancer-specific mortality, each unit of functional decline (HR=1.17, 95% CI 1.05 to 1.31) and decline in the ability to sit ≥1 h (HR=2.06, 95% CI 1.13 to 3.76) were associated with increased risk of breast cancer-specific mortality. Measures of functional decline were associated with increased risk of breast cancer mortality in overweight and obese women, but not in women of normal weight.

Conclusions Whereas functional limitations were associated with increased risk of other-cause mortality, functional decline was associated with increased risk of breast cancer mortality.

  • Mortality
  • Survival
  • Functional limitations
  • Functional decline

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/

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