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Int J Cancer. 2019 Oct 10. doi: 10.1002/ijc.32727. [Epub ahead of print]

The multimorbidity profile of South African women newly diagnosed with breast cancer.

Author information

1
Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, Gauteng, South Africa.
2
SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Pediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa.
3
South Africa Medical Research Council Common Epithelial Cancers Research Centre, University of Witwatersrand, Johannesburg, Gauteng, South Africa.
4
Department of Surgery, Chris Hani Baragwanath Academic Hospital and Faculty of Health Sciences, University of Witwatersrand, Johannesburg, Gauteng, South Africa.
5
Department of Surgery, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of Witwatersrand, Johannesburg, Gauteng, South Africa.
6
Department of Surgery and Oncology, Inkosi Albert Luthuli Central Hospital, Durban and Ngwelezane Hospital, University of KwaZulu Natal, Empangeni, KwaZulu Natal, South Africa.
7
Department of Surgery and Oncology, Grey's Hospital, University of KwaZulu Natal, Pietermaritzburg, KwaZulu Natal, South Africa.
8
National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa.
9
Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
10
Section for Environment and Radiation, International Agency for Research on Cancer, Lyon, France.
11
Department of Medicine, University of Miami Miller School of Medicine, Miami, FL.
12
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.
13
Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY.
14
Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY.
15
Division of Medical Oncology, Department of Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, Gauteng, South Africa.

Abstract

Multimorbidity in women with breast cancer may delay presentation, affect treatment decisions and outcomes. We described the multimorbidity profile of women with breast cancer, its determinants, associations with stage at diagnosis and treatments received. We collected self-reported data on five chronic conditions (hypertension, diabetes, cerebrovascular diseases, asthma/chronic obstructive pulmonary disease, tuberculosis), determined obesity using body mass index (BMI) and tested HIV status, in women newly diagnosed with breast cancer between January 2016 and April 2018 in five public hospitals in South Africa. We identified determinants of ≥2 of the seven above-mentioned conditions (defined as multimorbidity), multimorbidity itself with stage at diagnosis (advanced [III-IV] vs. early [0-II]) and multimorbidity with treatment modalities received. Among 2,281 women, 1,001 (44%) presented with multimorbidity. Obesity (52.8%), hypertension (41.3%), HIV (22.0%) and diabetes (13.7%) were the chronic conditions that occurred most frequently. Multimorbidity was more common with older age (OR = 1.02; 95% CI 1.01-1.03) and higher household socioeconomic status (HSES) (OR = 1.06; 95% CI 1.00-1.13). Multimorbidity was not associated with advanced-stage breast cancer at diagnosis, but for self-reported hypertension there was less likelihood of being diagnosed with advanced-stage disease in the adjusted model (OR 0.80; 95% CI 0.64-0.98). Multimorbidity was associated with first treatment received in those with early-stage disease, p = 0.003. The prevalence of multimorbidity is high among patients with breast cancer. Our findings suggest that multimorbidity had a significant impact on treatment received in those with early-stage disease. There is need to understand the impact of multimorbidity on breast cancer outcomes.

KEYWORDS:

breast cancer; chronic conditions; multimorbidity; stage at diagnosis and South African women

PMID:
31600408
DOI:
10.1002/ijc.32727

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