Objective:To characterize complex multimorbidity among cancer survivors and evaluate the association between cancer survivorship,time since cancer diagnosis,and self-reported fair/poor health,self-rated worse health i...Objective:To characterize complex multimorbidity among cancer survivors and evaluate the association between cancer survivorship,time since cancer diagnosis,and self-reported fair/poor health,self-rated worse health in 2 years,and 2-year mortality.Methods:We used the 2010-2012 Health and Retirement Study.Cancer survivors were indi-viduals who reported a(nonskin)cancer diagnosis 2 years or more before the interview.We defined complex multimorbidity as the co-occurrence of chronic conditions,functional limitations,and/or geriatric syndromes.In addition to descriptive analyses,we used logistic regression to evaluate the independent association between cancer survivor status and health outcomes.We also examined whether cancer survivorship differed by the number of years since diagnosis.Results:Among 15,808 older adults(age≥50 years),11.8%were cancer survivors.Compared with cancer-free individuals,a greater percentage of cancer survivors had complex multimorbidity:co-occurring chronic conditions,functional limitations,and geriatric syndromes.Cancer survivor-ship was significantly associated with self-reported fair/poor health,self-rated worse health in 2 years,and 2-year mortality.These effects declined with the number of years since diagnosis for fair/poor health and mortality but not for self-rated worse health.Conclusion:Cancer survivor status is independently associated with more complex multi-morbidity,and with worse health outcomes.These effects attenuate with time,except for patient perception of being in worse health.展开更多
Although African Americans(AAs)are less likely to get breast cancer than European Americans(EAs),they get more aggressive forms.We previously showed that short sleep is associated with higher tumor grade.It is well do...Although African Americans(AAs)are less likely to get breast cancer than European Americans(EAs),they get more aggressive forms.We previously showed that short sleep is associated with higher tumor grade.It is well documented that AAs get less sleep,on average,than EAs.We studied the contribution of short sleep to racial disparities in breast cancer aggressiveness among 809 invasive breast cancer patients who responded to a survey on their lifestyle.Multivariable regressions and mediation analyses were performed to assess the effect of sleep duration on the association of race with tumor grade.AAs reported shorter average sleep(mean[standard devia-tion]6.57[1.47]h)than EAs(mean[standard deviation]7.11[1.16]h;P<0.0001)and were almost twice as likely to report less than 6 h of sleep per night(48.0%vs.25.3%,P<0.0001).AA patients were more likely to have high-grade tumors(52.6%vs.28.7%in EAs,P=0.0002).In multivariate analysis,race was associated with tumor grade(P<0.0001).On adjustment for sleep duration,the effect of race was reduced by 7.1%,but remained statistically significant(P=0.0006).However,the Sobel test did not indicate statistical significance(z=1.69,P=0.091).In other models accounting for these and additional confounders,we found similar results.Because of the conservative nature of the mediation analysis and smaller sample size,replication of our results in larger studies with more AA patients is warranted.展开更多
基金This study was funded in part by Case Comprehensive Cancer Center support grant(P30 CA043703)。
文摘Objective:To characterize complex multimorbidity among cancer survivors and evaluate the association between cancer survivorship,time since cancer diagnosis,and self-reported fair/poor health,self-rated worse health in 2 years,and 2-year mortality.Methods:We used the 2010-2012 Health and Retirement Study.Cancer survivors were indi-viduals who reported a(nonskin)cancer diagnosis 2 years or more before the interview.We defined complex multimorbidity as the co-occurrence of chronic conditions,functional limitations,and/or geriatric syndromes.In addition to descriptive analyses,we used logistic regression to evaluate the independent association between cancer survivor status and health outcomes.We also examined whether cancer survivorship differed by the number of years since diagnosis.Results:Among 15,808 older adults(age≥50 years),11.8%were cancer survivors.Compared with cancer-free individuals,a greater percentage of cancer survivors had complex multimorbidity:co-occurring chronic conditions,functional limitations,and geriatric syndromes.Cancer survivor-ship was significantly associated with self-reported fair/poor health,self-rated worse health in 2 years,and 2-year mortality.These effects declined with the number of years since diagnosis for fair/poor health and mortality but not for self-rated worse health.Conclusion:Cancer survivor status is independently associated with more complex multi-morbidity,and with worse health outcomes.These effects attenuate with time,except for patient perception of being in worse health.
基金Funding for this study was provided from the National Cancer Institute(K07CA136758)the Case Comprehensive Cancer Center(P30CA043703).
文摘Although African Americans(AAs)are less likely to get breast cancer than European Americans(EAs),they get more aggressive forms.We previously showed that short sleep is associated with higher tumor grade.It is well documented that AAs get less sleep,on average,than EAs.We studied the contribution of short sleep to racial disparities in breast cancer aggressiveness among 809 invasive breast cancer patients who responded to a survey on their lifestyle.Multivariable regressions and mediation analyses were performed to assess the effect of sleep duration on the association of race with tumor grade.AAs reported shorter average sleep(mean[standard devia-tion]6.57[1.47]h)than EAs(mean[standard deviation]7.11[1.16]h;P<0.0001)and were almost twice as likely to report less than 6 h of sleep per night(48.0%vs.25.3%,P<0.0001).AA patients were more likely to have high-grade tumors(52.6%vs.28.7%in EAs,P=0.0002).In multivariate analysis,race was associated with tumor grade(P<0.0001).On adjustment for sleep duration,the effect of race was reduced by 7.1%,but remained statistically significant(P=0.0006).However,the Sobel test did not indicate statistical significance(z=1.69,P=0.091).In other models accounting for these and additional confounders,we found similar results.Because of the conservative nature of the mediation analysis and smaller sample size,replication of our results in larger studies with more AA patients is warranted.
