Accelerated aging in breast cancer survivors and its association with mortality and cancer recurrence

Abstract

Purpose: To prospectively investigate accelerated aging and its association with total mortality and breast cancer-specific mortality/recurrence among breast cancer survivors.

Methods: This study included 4218 female breast cancer patients enrolled into a population-based cohort study approximately 6-month post-diagnosis. Information on aging-related symptoms (i.e., self-rated overall health condition, energy level, depression, sleep difficulty, and quality) was collected at 18- and 36-month post-diagnosis surveys. Information on overall health, daily function impairments, survival status, and recurrence was collected at 10-year post-diagnosis survey. Record linkages with vital statistics were conducted to collect mortality information. Cox proportional hazards model was applied.

Results: Among 3041 10-year survivors with a mean age of 63.7 ± 9.7 years, respectively, 52.3%, 19.0%, and 27.6% reported poor health, limitation in daily activity, and climbing floors. Age-specific prevalence revealed that breast cancer survivors reached similar prevalence of the functional limitations 5-10 years earlier than cancer-free women. At the 18-month post-diagnosis survey, respectively, 47.0%, 72.5%, and 25.1% of survivors reported unsatisfied overall health condition, reduced energy level, and depression symptoms. After a median follow-up of 10.9 years, low self-rated overall health, low energy level, and depression were significantly associated with increased total mortality, with hazard ratios (HRs; 95% confidence intervals [CI]) of 3.14 (2.43, 4.06), 1.49 (1.20, 1.84), and 1.59 (1.21, 2.09), respectively. Low self-rated health was associated with breast cancer-specific mortality/recurrence (HR 1.85, 95% CI 1.30, 2.65). No significant association was found for sleep difficulty and quality.

Conclusion: Aging-related physical changes/symptoms are commonly presented at 18 months after breast cancer diagnosis and are associated with worse prognosis.

Impact: Our findings highlight the concern of accelerated aging among breast cancer survivors.

Keywords: Accelerated aging; Breast cancer; Depression; Energy; Mortality; Self-rated health; Sleep.

Figure 1.

Age-specific prevalence of aging-related symptoms among breast cancer survivors and cancer-free women. A. Prevalence of restriction to perform moderate daily activities; B. Prevalence of limited ability to climb stairs. C. Prevalence of poor self-rated health condition. A total of 3,041 10-year breast cancer survivors from SBCSS (age range: 32–88 year) and 48,010 cancer-free women from SWHS (age range: 51–89 year) were included in this analysis, of whom 293 breast cancer survivors did not answer the two questions on functional limitations. Abbreviations: SBCSS, Shanghai Breast Cancer Survivor Study; SWHS, Shanghai Women Health Study.