Functional consequences of the common diseases of aging are of
particular importance in geriatric medicine. Breast cancer is the most
common neoplasm in women, with an increase in incidence with age. The
diagnosis and treatment of breast cancer results in decreased
functioning in physical and psychosocial domains, which have a major
effect on an older woman's daily life. The existing studies of quality
of life outcomes after breast cancer have been hampered by several
limitations, such as failure to consider age-related differences; lack
of pre-illness measures of functional status; absence of appropriate
comparison groups (disease-free women); small sample sizes; and lack of
standardization in instruments selected to measure quality of life.
The proposed study will prospectively examine the age-related impact of
breast cancer on physical and psychosocial function among approximately
3,520 cases of breast cancer. The study will take place in two large
on-going longitudinal studies: the Nurses' Health Study (NHS) and the
Nurses' Health Study II (NHS-II). The NHS is a prospective cohort of
121,700 community dwelling women aged 50-76 in 1996 and the NHS-II is
a similarly designed prospective cohort of 116,686 women aged 35-50 in
1996. We propose to undertake a comprehensive assessment of function on
two levels -- generic quality of life and cancer-specific quality of
life. The particular strengths of our proposed study include pre-cancer
levels of physical and psychosocial function; ability to compare
functional outcomes among older breast cancer patients to healthy
controls as well as younger patients; prospective study design; large
sample size; high response rate; extensive information on potential
confounding factors and effect modifiers (such as disease severity and
treatment, co-morbid conditions, and social networks); and the use of
standardized and well-validated instruments to assess functional status
and quality of life.
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