An estimated 178,700 women were diagnosed with breast cancer in 1998, more than half of whom were 65 years of age or older. This proportion is likely to grow, not only because older age is the most important risk factor for breast cancer, but because gains in life expectancy and decreases in deaths due to cardiovascular disease will result in more women at risk for longer periods of time. Older women are at risk for receiving less than definitive care for their breast cancer and emerging evidence suggests that this translates into poorer health outcomes. We are studying 900 breast cancer patients at least 65 years of age who are at intermediate or high risk of breast cancer recurrence to identify physician and patient predictors of tamoxifen prescription and one year treatment adherence. We propose to follow this cohort, enrolled at four different geographic sites (Los Angeles, Minnesota, Rhode Island, and North Carolina) for five years to answer critical questions about the relationships between breast cancer treatments and disease-specific and health-related quality of life outcomes. Specifically, we propose to: (l) compare the effectiveness of adjuvant tamoxifen therapy, versus no adjuvant tamoxifen therapy, in reducing breast cancer recurrence and breast cancer mortality rates among older women receiving recommended definitive primary tumor therapies and those not receiving such therapies; (2) quantify the prevalence of tamoxifen discontinuance and identify patient and physician characteristics associated with it during the recommended five years of therapy; and (3) identify risk factors associated with a decline in health-related quality of life outcomes, particularly upper body function, during five years after breast cancer diagnosis. In the parent project, patients are interviewed 3, 6, and 15 months after their definitive surgery; medical record abstractions are performed; and breast cancer physicians provide information about treatments recommended. In the proposed project we will interview the same patients at months 27, 39, and 51 after their definitive surgery; obtain additional physician recommendation information at 30 months; and obtain semi-annual medical record-documented breast cancer recurrence information as well as National Death Index cause-specific mortality information. Findings from this study will characterize the effectiveness of adjuvant tamoxifen therapy in reducing rates of breast cancer recurrence and breast cancer-specific mortality among older women at high risk for recurrence who are cared for in community practice settings. The findings will also allow us to identify women most likely to discontinue tamoxifen therapy and those most likely to experience a significant decline in health-related quality of life during the first five years following the diagnosis of breast cancer.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
5R01CA084506-04
Application #
6603985
Study Section
Special Emphasis Panel (ZHS1-SRBB-D (03))
Program Officer
Aziz, Noreen M
Project Start
2000-06-01
Project End
2005-05-31
Budget Start
2003-06-01
Budget End
2005-05-31
Support Year
4
Fiscal Year
2003
Total Cost
$673,558
Indirect Cost
Name
Boston Medical Center
Department
Type
DUNS #
005492160
City
Boston
State
MA
Country
United States
Zip Code
02118
Dumontier, Clark; Clough-Gorr, Kerri M; Silliman, Rebecca A et al. (2017) Motivation and mortality in older women with early stage breast cancer: A longitudinal study with ten years of follow-up. J Geriatr Oncol 8:133-139
Eng, Jessica A; Clough-Gorr, Kerri; Cabral, Howard J et al. (2015) Predicting 5- and 10-year survival in older women with early-stage breast cancer: self-rated health and walking ability. J Am Geriatr Soc 63:757-62
Sehl, Mary; Lu, Xiang; Silliman, Rebecca et al. (2013) Decline in physical functioning in first 2 years after breast cancer diagnosis predicts 10-year survival in older women. J Cancer Surviv 7:20-31
Moser, André; Stuck, Andreas E; Silliman, Rebecca A et al. (2012) The eight-item modified Medical Outcomes Study Social Support Survey: psychometric evaluation showed excellent performance. J Clin Epidemiol 65:1107-16
Clough-Gorr, Kerri M; Thwin, Soe Soe; Stuck, Andreas E et al. (2012) Examining five- and ten-year survival in older women with breast cancer using cancer-specific geriatric assessment. Eur J Cancer 48:805-12
Haque, Reina; Yood, Marianne Ulcickas; Geiger, Ann M et al. (2011) Long-term safety of radiotherapy and breast cancer laterality in older survivors. Cancer Epidemiol Biomarkers Prev 20:2120-6
Clough-Gorr, Kerri M; Stuck, Andreas E; Thwin, Soe Soe et al. (2010) Older breast cancer survivors: geriatric assessment domains are associated with poor tolerance of treatment adverse effects and predict mortality over 7 years of follow-up. J Clin Oncol 28:380-6
Hanchate, Amresh D; Clough-Gorr, Kerri M; Ash, Arlene S et al. (2010) Longitudinal patterns in survival, comorbidity, healthcare utilization and quality of care among older women following breast cancer diagnosis. J Gen Intern Med 25:1045-50
Clough-Gorr, Kerri M; Ganz, Patricia A; Silliman, Rebecca A (2010) Older breast cancer survivors: factors associated with self-reported symptoms of persistent lymphedema over 7 years of follow-up. Breast J 16:147-55
Clough-Gorr, Kerri M; Rakowski, William; Clark, Melissa et al. (2009) The Getting-Out-of-Bed (GoB) scale: a measure of motivation and life outlook in older adults with cancer. J Psychosoc Oncol 27:454-68

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