Context: 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.
Subject (authority = RUETD)
Topic
Public Health
Subject (authority = ETD-LCSH)
Topic
Chronic diseases
Subject (authority = ETD-LCSH)
Topic
Breast--Cancer
Subject (authority = ETD-LCSH)
Topic
Older women--Diseases
RelatedItem (type = host)
TitleInfo
Title
Rutgers University Electronic Theses and Dissertations
Identifier (type = RULIB)
ETD
Identifier
ETD_6312
PhysicalDescription
Form (authority = gmd)
electronic resource
InternetMediaType
application/pdf
InternetMediaType
text/xml
Extent
1 online resource (ix, 101 p. : ill.)
Note (type = degree)
Ph.D.
Note (type = bibliography)
Includes bibliographical references
Note (type = statement of responsibility)
by Melissa L. Santorelli
RelatedItem (type = host)
TitleInfo
Title
Graduate School - New Brunswick Electronic Theses and Dissertations
Identifier (type = local)
rucore19991600001
Location
PhysicalLocation (authority = marcorg); (displayLabel = Rutgers, The State University of New Jersey)
Rutgers University. Graduate School - New Brunswick
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Type
License
Name
Author Agreement License
Detail
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