Division of Hematology/Oncology, Department of Medicine, Case Western Reserve School of Medicine, Cleveland, Ohio; Case Comprehensive Cancer Center, Cleveland, Ohio.
Cancer. 2013 Nov 1;119(21):3839-46. doi: 10.1002/cncr.28232. Epub 2013 Sep 23.
This study sought to assess racial differences in functional disability among older women with nonmetastatic breast cancer.
In this cross-sectional study, between April 2008 and December 2012, women aged ≥ 65 years with newly diagnosed stage I through III breast cancer were recruited from ambulatory oncology clinics at an academic center. Prior to receiving any adjuvant treatment, participants completed a comprehensive geriatric assessment. The primary outcome was functional disability, defined as dependency in any basic or instrumental activity of daily living, categorized as "yes" or "no." Logistic regression analyses were undertaken.
The study enrolled 190 women whose mean age was 75.0 years at diagnosis (standard deviation = 7.0, range = 65-93 years). Thirty-two percent were African American (AA), and 39% had functional disability. Controlling for age, participants with functional disability were more likely to be AA (versus non-Hispanic white), odds ratio = 4.19, 95% confidence interval = 2.12-8.27. Fifty-nine percent of the racial difference in functional disability was explained by a higher prevalence of lower income and education among AAs. In addition, the higher prevalence of chronic medical conditions and obesity among AAs, after accounting for socioeconomic factors, further explained 40% of the black-white difference in functional disability.
Among older women with newly diagnosed nonmetastatic breast cancer, functional disability is highly prevalent, and AAs are disproportionately affected. Interventions to optimize the functional status of at-risk individuals, particularly AAs, during and after cancer treatment may improve treatment tolerance and overall survival outcomes.
本研究旨在评估非转移性乳腺癌老年女性的功能障碍的种族差异。
在这项横断面研究中，2008 年 4 月至 2012 年 12 月，从学术中心的门诊肿瘤诊所招募了年龄≥65 岁、新诊断为 I 期至 III 期乳腺癌的女性。在接受任何辅助治疗之前，参与者完成了全面的老年评估。主要结局是功能障碍，定义为日常生活中任何基本或工具性活动的依赖，分为“是”或“否”。进行了逻辑回归分析。
该研究纳入了 190 名女性，诊断时的平均年龄为 75.0 岁（标准差=7.0，范围为 65-93 岁）。32%为非裔美国人（AA），39%存在功能障碍。控制年龄后，有功能障碍的参与者更有可能是 AA（而非非西班牙裔白人），比值比=4.19，95%置信区间=2.12-8.27。功能障碍的种族差异中，59%可由 AA 中较低收入和教育程度的较高患病率来解释。此外，在考虑社会经济因素后，AA 中慢性疾病和肥胖的更高患病率进一步解释了功能障碍的黑-白差异的 40%。
在新诊断为非转移性乳腺癌的老年女性中，功能障碍的患病率很高，非裔美国人 disproportionately 受到影响。在癌症治疗期间和之后，针对高危个体（特别是非裔美国人）优化功能状态的干预措施可能会改善治疗耐受性和整体生存结果。
