Journal Article

Multimorbidity and overall survival among women with breast cancer: results from the South African Breast Cancer and HIV Outcomes Study

McCormack, Valerie, Ruff, Paul, Nietz, Sarah, Čačala, Sharon, O’Neil, Daniel S., Neugut, Alfred I., Mapanga, Witness, Joffe, Maureen, Jacobson, Judith S., Chirwa, Tobias, Ayeni, Oluwatosin A., Ramiah, Duvern, Norris, Shane A., Cubasch, Herbert, Stopforth, Laura W., Micklesfield, Lisa K., Phakathi, Boitumelo, Buccimazza, Ines, Crew, Katherine D., Chen, Wenlong Carl

2023

Overview

Background Breast cancer survival in South Africa is low, but when diagnosed with breast cancer, many women in South Africa also have other chronic conditions. We investigated the impact of multimorbidity (≥ 2 other chronic conditions) on overall survival among women with breast cancer in South Africa. Methods Between 1 July 2015 and 31 December 2019, we enrolled women newly diagnosed with breast cancer at six public hospitals participating in the South African Breast Cancer and HIV Outcomes (SABCHO) Study. We examined seven chronic conditions (obesity, hypertension, diabetes, HIV, cerebrovascular diseases (CVD), asthma/chronic obstructive pulmonary disease, and tuberculosis), and we compared socio-demographic, clinical, and treatment factors between patients with and without each condition, and with and without multimorbidity. We investigated the association of multimorbidity with overall survival using multivariable Cox proportional hazard models. Results Of 3,261 women included in the analysis, 45% had multimorbidity; obesity (53%), hypertension (41%), HIV (22%), and diabetes (13%) were the most common individual conditions. Women with multimorbidity had poorer overall survival at 3 years than women without multimorbidity in both the full cohort (60.8% vs. 64.3%, p  = 0.036) and stage groups: stages I–II, 80.7% vs. 86.3% ( p  = 0.005), and stage III, 53.0% vs. 59.4% ( p  = 0.024). In an adjusted model, women with diabetes (hazard ratio (HR) = 1.20, 95% confidence interval (CI) = 1.03–1.41), CVD (HR = 1.43, 95% CI = 1.17–1.76), HIV (HR = 1.21, 95% CI = 1.06–1.38), obesity + HIV (HR = 1.24 95% CI = 1.04–1.48), and multimorbidity (HR = 1.26, 95% CI = 1.13–1.40) had poorer overall survival than women without these conditions. Conclusions Irrespective of the stage, multimorbidity at breast cancer diagnosis was an important prognostic factor for survival in our SABCHO cohort. The high prevalence of multimorbidity in our cohort calls for more comprehensive care to improve outcomes for South African women with breast cancer.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Age / Asthma / Biomedical and Life Sciences / Biomedicine / Breast cancer / Breast Neoplasms / Cancer / Cancer Research / Cancer therapies / Cerebrovascular diseases / Chemotherapy / Chronic conditions / Chronic Disease / Chronic illnesses / Chronic obstructive pulmonary disease / Committees / Comorbidity / Diabetes / Diabetes mellitus / Diabetes Mellitus - epidemiology / Diabetics / Diagnosis / Female / HIV / HIV (Viruses) / HIV Infections - complications / HIV Infections - epidemiology / Hospitals / Human immunodeficiency virus / Humans / Hypertension / Hypertension - epidemiology / Lifestyles / Lung diseases / Mammography / Medical diagnosis / Medical prognosis / Mortality / Multimorbidity / Obesity / Obesity - complications / Obstructive lung disease / Oncology / Oncology, Experimental / Patient outcomes / Patients / Quality of life / Sociodemographics / Socioeconomic factors / South Africa / South Africa - epidemiology / Surgical Oncology / Survival / Tuberculosis / Vascular diseases / Women / Womens health