The persistent impact of breast carcinoma on functional health status - Prospective evidence from the nurses' health study

BACKGROUND. Although physical and emotional function after the diagnosis of breast carcinoma have been described in clinic populations, to the authors ' knowledge no previous study has measured change from the preillness level of functional health status in community-dwelling women. METHODS, The authors conducted a 4-year (1992-96) prospective study of func tional recovery after breast carcinoma in a large sample of women, aged 54- 73 years. They collected multidimensional measures of self-reported functio nal health status in 1992, before diagnosis of breast carcinoma, and again in 1996, to examine the risk of decline associated with incident breast car cinoma. RESULTS, After adjustment for age, baseline functional health status, and m ultiple covariates, women who developed incident breast carcinoma were more likely to have experienced reduced physical function, role function, vital ity, and social function and increased bodily pain compared with women who remained free of breast carcinoma. Risk of decline was attenuated with incr easing time since diagnosis. Risk of decline in physical function was evide nt across all stages of breast carcinoma, even after adjustment for women u ndergoing treatment for persistent or recurrent disease. We found evidence that the risk of decline among breast carcinoma cases compared with healthy women was largest among those who were most socially isolated. CONCLUSIONS, Breast carcinoma results in persistent declines in multiple di mensions of functional health status. These prospective data suggest that p revious studies reporting no difference in physical function among breast c arcinoma cases compared with disease free women underestimated the deleteri ous effect of the disease on function. Socially isolated women are an espec ially vulnerable group. Cancer 2000;89:2176-86. (C) 2000 American Cancer So ciety.