Upper-body strength and breast cancer: a comparison of the effects of age and disease.

Background. In most studies of functional limitations in women with breast cancer, it is difficult to determine what difficulties are associated with breast cancer and what problems are likely to be found in women of the same age without the disease. In the present study, we report the age-specific prevalence of upper-body limitations in women with breast cancer over the course of one year, compared to that experienced by women of the same age without the disease. Methods. Interviews were conducted with women with breast cancer ages 40-84 at 3 months (n = 934) and 12 months after diagnosis (n = 843). Controls were interviewed twice over the same period (n = 991 and 887, respectively). The main outcome was upper-body limitation, defined as the number of tasks requiring upper-body strength (0-4) reported by the respondent to be very difficult to complete or not done on doctor's orders. Results. Cases ages 40-54, 55-64, and 65-74 were approximately twice as likely as age-matched controls to report upper-body limitations, adjusting for race, education, financial status, and comorbidity. There was no case/control difference among those ages 75-84. At one year, the breast cancer patients ages 40-54 and 55-64 showed the greatest improvement. Conclusions. Many women who survive breast cancer report significant limitations in upper-body strength in the first few months, followed, especially among younger women, by a period of recuperation. Rehabilitation and home-care programs should be designed to meet the special and more persistent needs of older women. New strategies for assessing upper-body strength are also suggested. I N an earlier study, we reported on difficulties in physical functioning reported by middle-aged and elderly women with breast cancer, compared to women of the same ages without the disease (1). We found that limitations in upperbody strength, i.e., pushing, lifting, and reaching, were especially problematic for women with breast cancer. At 3 months after diagnosis, patients aged 55-64 and 65-74 reported greater difficulty than controls of the same age in completing tasks involving upper-body strength. However, cases aged 75-84 were not disadvantaged in upper-body strength, when compared to controls, perhaps because of the high prevalence of concurrent health conditions among women in this age group. Most cases recuperated over the subsequent 9 months. At 12 months after diagnosis, cases aged 55-64 seem to have greater functional reserves, enabling them to return to normal functioning more quickly than those aged 65-74, who seemed to have the most persistent problems. Cases aged 75-84 continued to have about the same level of difficulty as controls. The results of a more detailed investigation of age differences in upper-body limitation among breast cancer cases and controls at 3 and 12 months after diagnosis are reported in this article. To confirm our previous estimates of physical limitations among older breast cancer patients, we enrolled a new cohort of cases and controls aged 75-84 to enhance sample size for this older age group. In addition, a younger group of women aged 40-54 was included, so that functional status could be examined across a broader age spectrum. We also assessed the effects of recuperation more precisely by using a repeated measures analysis to examine changes in functional status between 3 and 12 months after diagnosis. Finally, we examined case/control differences more clearly by adjusting for the effects of selected covariates, including comorbidity.