Study suggests healthy habits before diagnosis may support greater functional reserve and recovery in breast cancer survivors
Older women experience sharp declines in physical function soon after being diagnosed with and treated for breast cancer — compared with similar-aged women without the disease — and they continue to have lower physical function even 10 years after diagnosis, according to new Kaiser Permanente research.
The study, published in the Journal of the National Cancer Institute, also found that women whose cancer had spread to nearby lymph nodes or tissues, were treated with chemotherapy, and age 75 and older were more likely to see their physical function decline.
“The clearest pattern we saw was an acute decline after diagnosis, followed by partial recovery,” said lead author Elizabeth Cespedes Feliciano, ScD, SM, a research scientist at the Kaiser Permanente Northern California Division of Research. “Older breast cancer survivors generally did not fully return to the physical-function levels of otherwise similar women without cancer, demonstrating that the effects of cancer and its treatments are substantial and long-lasting.”
Previous research led by Cespedes Feliciano found that post-menopausal survivors of the 4 most common types of cancer — breast, colorectal, lung, or uterine — reported worse physical function than women who had never been diagnosed with cancer.
For their study, Cespedes Feliciano and her team used information collected from 45,530 participants in the Women’s Health Initiative (WHI), the landmark long-term national health study launched in 1991 at Fred Hutchinson Cancer Center that enrolled women ages 50 through 70.
Within this group, 8,334 women were diagnosed with localized breast cancer (in the breast only) or regional breast cancer (tumors that have spread to nearby lymph nodes or tissue but not to other areas of the body). The median age at diagnosis was 72.
The researchers matched the women who were diagnosed with breast cancer to similar women in the WHI who had not had cancer. To measure physical function, the researchers used data from the annual surveys on health and self-care WHI participants completed.
The surveys were scored from 0 to 100. A score between 51 and 85 indicates moderate physical limitation; a score of 50 or less indicates substantial physical limitations. The researchers looked at how the scores changed over a 10-year period.
Acute decline after diagnosis
The study showed women with localized breast cancer had physical function scores similar to those of the women without breast cancer at diagnosis. After an initial decline, these women’s scores then leveled out.
In contrast, women with regional breast cancer had lower scores at diagnosis, a more dramatic decline, and less recovery. In this group, a 7-point gap in scores — about a 6-year difference in physical function — was seen at one year after diagnosis between the breast cancer survivors and their counterparts. Ten years after diagnosis, a 5-point gap — equivalent to about 5 years of physical function — remained between the two groups.
“What we are seeing could best be described as accelerated aging,” said Cespedes Feliciano. “Cancer is a disease of aging, but this study, like our prior study, shows that cancer ages you. And its treatments do as well. Chemotherapy, for example, is known to cause fatigue and reduce activity. But chemotherapy also speeds biological aging, which can further reduce physical function.”
The study also found that women who reported having a healthy lifestyle that included not smoking, exercising regularly, and maintaining a healthy diet were more likely to have higher physical function scores at diagnosis. These women also were more likely to recover more fully over time.
These findings reinforce existing research showing a healthy lifestyle can benefit breast cancer survivors. They also underscore the importance of the lifestyle medicine programs Kaiser Permanente Northern California (KPNC) offers for breast cancer survivors across its medical centers, said Veronica Shim, MD, director of the KPNC Breast Care Center.
“The journey beyond breast cancer is supported by more than medical treatment,” she said. “Social connection, physical activity, healthy weight management, a plant-forward diet, and avoiding alcohol can all help breast cancer survivors live healthier, longer lives.”
The study was funded by the National Cancer Institute.
Co-authors include Sophia E. Fuller, MA, Joshua R. Nugent, PhD, Anlan Cao, PhD, MBBS, and Bette J. Caan, DrPH, from the Division of Research, and investigators from the Fred Hutchinson Cancer Center, Ohio State University, University of Toronto, University of Buffalo, Harvard Medical School, and University of California, Los Angeles, Hawaii, and San Diego.
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About the Kaiser Permanente Division of Research
The Kaiser Permanente Division of Research conducts, publishes, and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large. KPDOR seeks to understand the determinants of illness and well-being and to improve the quality and cost-effectiveness of health care. Currently, DOR’s 720-plus staff, including 73 research and staff scientists, are working on nearly 630 epidemiological and health services research projects. For more information, visit divisionofresearch.kp.org.
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