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Chronic disease outcomes among older women with breast cancer in the united states
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Santorelli, Melissa L.. Chronic disease outcomes among older women with breast cancer in the united states. Retrieved from https://doi.org/doi:10.7282/T3KS6TCF

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TitleChronic disease outcomes among older women with breast cancer in the united states
NameSantorelli, Melissa L. (author); DEMISSIE, KITAW (chair); Steinberg, Michael B (internal member); Rhoads, George G (internal member); LIN, YONG (internal member); Hirshfield, Kim M (outside member); Rutgers University; Graduate School - New Brunswick
Date Created2015
Other Date2015-05 (degree)
SubjectPublic Health, Chronic diseases, Breast--Cancer, Older women--Diseases
Extent1 online resource (ix, 101 p. : ill.)
DescriptionContext: Improving survival has raised important questions about the long term health of breast cancer patients, particularly for older women who experience the highest incidence and who are more likely to have or develop other chronic health conditions. Specific Aims: The specific aims of this dissertation were to: 1) Examine racial differences in the effects of comorbidity on survival in elderly breast cancer patients (Study 1); 2) Investigate the effects of breast cancer on chronic disease medication adherence in the elderly (Study 2); and 3) Investigate the effects of hormonal therapy for breast cancer on diabetes incidence in postmenopausal women (Study 3). Design, Setting, and Subjects: The Surveillance, Epidemiology and End Results (SEER) – Medicare linked data were used to select stage I-III breast cancer patients for the above retrospective cohort studies. Women from a 5% random sample of Medicare enrollees living in SEER areas were selected as comparison subjects for studies two and three. Results: A competing risk survival analysis in the first study failed to find racial differences in the effects of comorbidity on breast cancer mortality after adjusting for age, year of diagnosis, and tumor characteristics. For other-cause mortality, the magnitude of adverse comorbidity effects were larger for white women overall (p=0.04). The second study showed an elevated risk of diabetes medication non-adherence for breast cancer versus comparison women after adjusting for age and race [Odds Ratio (OR) = 1.41; 95% Confidence Interval (CI) = 1.05 to 1.90]. Women with breast cancer were also more likely to be non-persistent with diabetes medication relative to women without cancer [Hazard Ratio (HR) = 1.29; 95% CI: 1.02 to 1.62]. The third study found no association between aromatase inhibitor use and new onset diabetes in the two years post-treatment initiation after adjusting for age, race, and comorbidity [HR: 0.99; 95% CI: 0.84 to 1.18]. Conclusion: The findings of this dissertation provide evidence that breast cancer affects chronic disease medication adherence and that hormonal therapy was not associated with the development of a new comorbidity. Special attention should be given to following breast cancer patients to ensure treatment of their comorbid conditions.
NotePh.D.
NoteIncludes bibliographical references
Noteby Melissa L. Santorelli
Genretheses, ETD doctoral
Persistent URLhttps://doi.org/doi:10.7282/T3KS6TCF
Languageeng
CollectionGraduate School - New Brunswick Electronic Theses and Dissertations
Organization NameRutgers, The State University of New Jersey
RightsThe author owns the copyright to this work.
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