Grant Number:	1R01CA084506-01 Interpret this number
Primary Investigator:	Silliman, Rebecca
Organization:	Boston Medical Center
Project Title:	Breast Cancer Treatment Outcomes in Older Women
Fiscal Year:	2000

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.




Motivation And Mortality In Older Women With Early Stage Breast Cancer: A Longitudinal Study With Ten Years Of Follow-up
Authors: Dumontier C. , Clough-Gorr K.M. , Silliman R.A. , Stuck A.E. , Moser A. .
Source: Journal Of Geriatric Oncology, 2016-12-13 00:00:00.0; , .
PMID: 27986501
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Predicting 5- and 10-year survival in older women with early-stage breast cancer: self-rated health and walking ability.
Authors: Eng J.A. , Clough-Gorr K. , Cabral H.J. , Silliman R.A. .
Source: Journal Of The American Geriatrics Society, 2015 Apr; 63(4), p. 757-62.
PMID: 25900489
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Decline in physical functioning in first 2 years after breast cancer diagnosis predicts 10-year survival in older women.
Authors: Sehl M. , Lu X. , Silliman R. , Ganz P.A. .
Source: Journal Of Cancer Survivorship : Research And Practice, 2013 Mar; 7(1), p. 20-31.
PMID: 23232922
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The eight-item modified Medical Outcomes Study Social Support Survey: psychometric evaluation showed excellent performance.
Authors: Moser A. , Stuck A.E. , Silliman R.A. , Ganz P.A. , Clough-Gorr K.M. .
Source: Journal Of Clinical Epidemiology, 2012 Oct; 65(10), p. 1107-16.
PMID: 22818947
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Examining five- and ten-year survival in older women with breast cancer using cancer-specific geriatric assessment.
Authors: Clough-Gorr K.M. , Thwin S.S. , Stuck A.E. , Silliman R.A. .
Source: European Journal Of Cancer (oxford, England : 1990), 2012 Apr; 48(6), p. 805-12.
PMID: 21741826
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Long-term Safety Of Radiotherapy And Breast Cancer Laterality In Older Survivors
Authors: Haque R. , Yood M.U. , Geiger A.M. , Kamineni A. , Avila C.C. , Shi J. , Silliman R.A. , Quinn V.P. .
Source: Cancer Epidemiology, Biomarkers & Prevention : A Publication Of The American Association For Cancer Research, Cosponsored By The American Society Of Preventive Oncology, 2011 Oct; 20(10), p. 2120-6.
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Longitudinal patterns in survival, comorbidity, healthcare utilization and quality of care among older women following breast cancer diagnosis.
Authors: Hanchate A.D. , Clough-Gorr K.M. , Ash A.S. , Thwin S.S. , Silliman R.A. .
Source: Journal Of General Internal Medicine, 2010 Oct; 25(10), p. 1045-50.
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Older breast cancer survivors: factors associated with self-reported symptoms of persistent lymphedema over 7 years of follow-up.
Authors: Clough-Gorr K.M. , Ganz P.A. , Silliman R.A. .
Source: The Breast Journal, 2010 Mar-Apr; 16(2), p. 147-55.
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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.
Authors: Clough-Gorr K.M. , Stuck A.E. , Thwin S.S. , Silliman R.A. .
Source: Journal Of Clinical Oncology : Official Journal Of The American Society Of Clinical Oncology, 2010-01-20 00:00:00.0; 28(3), p. 380-6.
EPub date: 2010-01-20 00:00:00.0.
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The Getting-Out-of-Bed (GoB) scale: a measure of motivation and life outlook in older adults with cancer.
Authors: Clough-Gorr K.M. , Rakowski W. , Clark M. , Silliman R.A. .
Source: Journal Of Psychosocial Oncology, 2009; 27(4), p. 454-68.
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Challenges associated with longitudinal survivorship research: attrition and a novel approach of reenrollment in a 6-year follow-up study of older breast cancer survivors.
Authors: Clough-Gorr K.M. , Fink A.K. , Silliman R.A. .
Source: Journal Of Cancer Survivorship : Research And Practice, 2008 Jun; 2(2), p. 95-103.
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Effectiveness Of Adjuvant Tamoxifen Therapy Among Older Women With Early Stage Breast Cancer
Authors: Owusu C. , Lash T.L. , Silliman R.A. .
Source: The Breast Journal, 2007 Jul-Aug; 13(4), p. 374-82.
PMID: 17593042
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Older breast cancer survivors: factors associated with change in emotional well-being.
Authors: Clough-Gorr K.M. , Ganz P.A. , Silliman R.A. .
Source: Journal Of Clinical Oncology : Official Journal Of The American Society Of Clinical Oncology, 2007-04-10 00:00:00.0; 25(11), p. 1334-40.
EPub date: 2007-04-10 00:00:00.0.
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Effect Of Undertreatment On The Disparity In Age-related Breast Cancer-specific Survival Among Older Women
Authors: Owusu C. , Lash T.L. , Silliman R.A. .
Source: Breast Cancer Research And Treatment, 2007 Apr; 102(2), p. 227-36.
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Adherence To Tamoxifen Over The Five-year Course
Authors: Lash T.L. , Fox M.P. , Westrup J.L. , Fink A.K. , Silliman R.A. .
Source: Breast Cancer Research And Treatment, 2006 Sep; 99(2), p. 215-20.
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Risk Of Decline In Upper-body Function And Symptoms Among Older Breast Cancer Patients
Authors: Westrup J.L. , Lash T.L. , Thwin S.S. , Silliman R.A. .
Source: Journal Of General Internal Medicine, 2006 Apr; 21(4), p. 327-33.
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Reduced Mortality Rate Associated With Annual Mammograms After Breast Cancer Therapy
Authors: Lash T.L. , Fox M.P. , Silliman R.A. .
Source: The Breast Journal, 2006 Jan-Feb; 12(1), p. 2-6.
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Predictors And Outcomes Of Surgeons' Referral Of Older Breast Cancer Patients To Medical Oncologists
Authors: Thwin S.S. , Fink A.K. , Lash T.L. , Silliman R.A. .
Source: Cancer, 2005-09-01 00:00:00.0; 104(5), p. 936-42.
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Patient Beliefs And Tamoxifen Discontinuance In Older Women With Estrogen Receptor--positive Breast Cancer
Authors: Fink A.K. , Gurwitz J. , Rakowski W. , Guadagnoli E. , Silliman R.A. .
Source: Journal Of Clinical Oncology : Official Journal Of The American Society Of Clinical Oncology, 2004-08-15 00:00:00.0; 22(16), p. 3309-15.
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The Relationship Among Physicians' Specialty, Perceptions Of The Risks And Benefits Of Adjuvant Tamoxifen Therapy, And Its Recommendation In Older Patients With Breast Cancer
Authors: Malek K. , Fink A.K. , Thwin S.S. , Gurwitz J. , Ganz P.A. , Silliman R.A. .
Source: Medical Care, 2004 Jul; 42(7), p. 700-6.
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Comorbidity: Implications For Research And Practice In Geriatric Oncology
Authors: Satariano W.A. , Silliman R.A. .
Source: Critical Reviews In Oncology/hematology, 2003 Nov; 48(2), p. 239-48.
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