Data from Predicting Health-Related Quality of Life Trajectories in Elderly Patients with Breast Cancer: From Prediagnosis to Long-term Follow-up

AbstractBackground: Evidence comparing patients’ health-related quality of life (HRQOL) before and after breast cancer diagnosis, and factors influencing these trajectories, is limited because of unpredictable onset. We analyzed predictors of HRQOL change in elderly patients with breast cancer across two transitions: pre- to post-diagnosis and at diagnosis versus 2 years later. Methods: Using Surveillance, Epidemiology, and End Results–Medicare Health Outcomes Survey linkage, we analyzed patients with breast cancer >65 years who completed two HRQOL surveys. Two cohorts were examined: patients with surveys before and within 1 year after diagnosis (cohort 1) and those with surveys within 1 year of diagnosis and 2 years after diagnosis (cohort 2). Bayesian regression identified predictors of physical component summary (PCS) and mental component summary (MCS) score changes. Results: In cohort 1 (n = 1,546), advanced stage was associated with greater HRQOL decline, with mean PCS changes ranging from −2.1 to −6.5 and MCS from −2.0 to −5.1. Baseline activities of daily living (ADL) limitations were associated with mean PCS declines ranging from −2.0 to −2.6 and mean MCS decline of −2.0. Better baseline health perception was protective with mean PCS increases ranging from +1.4 to +3.4. In cohort 2 (n = 891), baseline ADL limitations were associated with mean PCS declines ranging from −1.6 to −5.5 and mean MCS decline of −2.5, whereas poor health perception was associated with mean PCS decline of −3.2. Excellent health perception was protective (mean MCS: +4.1). Surgery, chemotherapy, and radiation had no HRQOL affect. Conclusions: Baseline health perception and ADL limitations are critical determinants of HRQOL trajectories, outweighing treatments. Impact: Early intervention strategies based on baseline assessments may improve survivorship.