Health-related quality of life trajectories among older breast cancer survivors: a SEER-MHOS analysis.

Background: As the survival of breast cancer patients continues to improve, health-related quality of life (HRQOL) becomes an important concern in survivorship. However, there is a lack of knowledge regarding long-term changes in HRQOL after diagnosis among older breast cancer survivors. This study examined HRQOL trajectories over 10 years after diagnosis.

Methods: Older women diagnosed with breast cancer at age ≥ 65 years in 1998-2017 in the SEER-MHOS database were eligible. These women must have participated in the surveys at least once within 24 months before diagnosis and at least twice within 10 years after diagnosis. HRQOL was measured using the SF-36/VR-12 questionnaire and summarized as physical (PCS) and mental component summary (MCS) scores. Latent class growth analysis was conducted to identify PCS and MCS trajectory groups. Exploratory descriptive analysis was conducted to characterize these groups.

Results: A total of 580 women met the eligibility criteria. There were three classes of PCS trajectory, with all showing declining over time with differing starting points: high-declining (35.5%), mid-declining (41.2%), and low-declining (23.3%). Two classes of MCS trajectory were identified with, all showing a maintaining trend: high-stable (72.3%) and low-recovering (27.7%). The individuals in a worse trajectory group were characterized by older age at diagnosis, higher body mass index, lower education, more comorbidities, more difficulty completing activities, and poor health perception at pre-diagnosis.

Conclusion: Older women showed declining PCS trajectories after breast cancer diagnosis while maintaining their MCS scores. These results suggest that more active and early interventions are needed to improve HRQOL deterioration in older breast cancer survivors, by incorporating comprehensive geriatric assessment and multidisciplinary geriatric oncology services.