Liu Yi-Shao, Liu Yan, Park Chanhyun
Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA.
Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX, USA.
J Geriatr Oncol. 2023 Sep;14(7):101598. doi: 10.1016/j.jgo.2023.101598. Epub 2023 Aug 5.
Due to the improved overall survival and life expectancy of older women with breast cancer, cardiovascular disease (CVD) arose as the primary cause of non-cancer-related deaths in this population. Therefore, assessing the health-related quality of life (HRQoL) of breast cancer patients with comorbid CVD is becoming increasingly vital. Our study aimed to evaluate the association between comorbid CVD and HRQoL among older women with early-stage breast cancer who are receiving adjuvant endocrine therapy (AET) in the United States.
We conducted a retrospective cohort study using the 2006-2017 Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey data. We identified female patients over the age of 65 who were diagnosed with stage I-III hormone receptor-positive breast cancer and treated with AET. HRQoL was assessed by the physical and mental component summary (PCS & MCS) in the health survey. CVD was defined as a history of acute myocardial infarction (AMI), congestive heart failure (CHF), angina, stroke, or other heart-related conditions. We performed multivariate linear regression models while controlling for covariates.
Among 3,904 older women, a history of CHF [β = -1.97, p = 0.025], stroke [β = -3.00, p < 0.010], or other heart-related condition [β = -1.10, p = 0.046] was significantly associated with lower PCS. However, no significant differences in PCS scores were found between women with a history of AMI or angina and those without these conditions. Having a history of CHF [β = -1.72, p = 0.033] or stroke [β = -1.48, p = 0.038] was significantly associated with lower MCS, whereas a history of angina, AMI, or other heart conditions was not associated with significant differences in MCS. Our study did not observe any significant differences in PCS and MCS between the two types AETs.
The study found that older women with early-stage breast cancer who were being treated with AETs had a lower HRQoL if they had a history of CHF or stroke. These comorbidities were identified as strong predictors for decreased HRQoL. The findings highlight the significance of managing cardiovascular diseases in such patients for better HRQoL while they receive AET treatment.
由于老年乳腺癌女性的总体生存率和预期寿命有所提高，心血管疾病（CVD）已成为该人群非癌症相关死亡的主要原因。因此，评估合并CVD的乳腺癌患者的健康相关生活质量（HRQoL）变得越来越重要。我们的研究旨在评估在美国接受辅助内分泌治疗（AET）的早期乳腺癌老年女性中，合并CVD与HRQoL之间的关联。
我们使用2006 - 2017年监测、流行病学和最终结果 - 医疗保险健康结果调查数据进行了一项回顾性队列研究。我们确定了年龄在65岁以上、被诊断为I - III期激素受体阳性乳腺癌并接受AET治疗的女性患者。通过健康调查中的身体和心理成分总结（PCS和MCS）来评估HRQoL。CVD被定义为急性心肌梗死（AMI）、充血性心力衰竭（CHF）、心绞痛、中风或其他心脏相关疾病的病史。我们在控制协变量的同时进行了多变量线性回归模型分析。
在3904名老年女性中，CHF病史[β = -1.97，p = 0.025]、中风病史[β = -3.00，p < 0.010]或其他心脏相关疾病病史[β = -1.10，p = 0.046]与较低的PCS显著相关。然而，有AMI或心绞痛病史的女性与没有这些疾病的女性在PCS评分上没有显著差异。有CHF病史[β = -1.72，p = 0.033]或中风病史[β = -1.48，p = 0.038]与较低的MCS显著相关，而心绞痛、AMI或其他心脏疾病病史与MCS的显著差异无关。我们的研究未观察到两种AET类型在PCS和MCS方面有任何显著差异。
该研究发现，接受AET治疗的早期乳腺癌老年女性如果有CHF或中风病史，其HRQoL较低。这些合并症被确定为HRQoL下降的强预测因素。研究结果强调了在这类患者接受AET治疗时，管理心血管疾病以提高HRQoL的重要性。
