The single largest percentage of survivors—22%—are women with breast cancer, and “most of what is known about cancer survivorship has stemmed from research conducted among breast cancer survivors,” noted de Moor et al.1 Of the nearly 3 million women who were survivors of breast cancer in 2012, almost 700,000 were aged 70 to 79 years old and 600,000 were aged 80 years or older.1
Dr. Rowland said survivors themselves have long advocated for information about what they can do to stay healthy after cancer treatment so they can both prevent disease recurrence and lower risk of future events. Also in this equation are considerations prior to initiation of treatment. For example, a woman with breast cancer who is blind and uses her fingers to read Braille would not want to run the risk of peripheral neuropathy from paclitaxel, for example, which would “dramatically change her quality of life,” she said.
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Several studies have sought to determine what comorbidities most affect older breast cancer survivors and how these might be mitigated.
A retrospective evaluation of cardiovascular disease (CVD) risk factors in women older than age 65 years at breast cancer diagnosis who had survived at least 5 years and were followed for a maximum of 15 years found that, compared with women without breast cancer, the strongest predictors of CVD were smoking history, diabetes, and hypertension. These results suggest that long-term prognosis “is affected by management of pre-existing conditions,” the authors concluded, adding that “assessment of comorbid conditions and effective management of diabetes and hypertension in older breast cancer survivors may lead to longer overall survival.”4
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To determine risk factors that could trigger development of CVD, osteoporosis, and hypertension, Obi et al studied more than 2,500 women aged 50 to 75 years at breast cancer diagnosis. Women treated with an aromatase inhibitor had increased risk for incident CVD (hazard ratio [HR], 1.42; 95% CI, 1.09-1.84) and osteoporosis (HR, 2.15; 95% CI, 1.64-2.82), while those treated with trastuzumab had an increased risk for hypertension (HR, 2.16; 95% CI, 1.09-4.33).5
Similarly, Dobek et al found that “exercise programs aimed at improving musculoskeletal health should be considered in the long-term care plan for breast cancer survivors,”6 although Lipscombe et al found that postmenopausal survivors of breast cancer are more likely to develop diabetes than those without breast cancer.7
Patients who have had cancer are also at higher risk for a second malignancy. Between 1975 and 2001, the first study to examine the prevalence of multiple cancers found that approximately 750,000 people had been affected by cancer more than once, with women who had primary breast cancer representing the greatest percentage, 25%, of all survivors with multiple cancers.8 The majority were aged 60 years or older.
