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

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

doi:10.1186/s13058-023-01603-w

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

Breast Cancer Res. 2023 Jan 23;25(1):7. doi: 10.1186/s13058-023-01603-w.

Authors

Oluwatosin A Ayeni^{1

2}, Maureen Joffe³, Witness Mapanga^{3

4}, Wenlong Carl Chen^{3

5

6}, Daniel S O'Neil⁷, Boitumelo Phakathi⁸, Sarah Nietz⁹, Ines Buccimazza⁸, Sharon Čačala^{8

10}, Laura W Stopforth^{8

11}, Judith S Jacobson^{12

13}, Katherine D Crew^{12

13

14}, Alfred I Neugut^{12

13

14}, Duvern Ramiah¹⁵, Paul Ruff^{3

16}, Herbert Cubasch^{3

9}, Tobias Chirwa¹⁷, Valerie McCormack¹⁸, Lisa K Micklesfield⁴, Shane A Norris^{4

19}

Affiliations

¹ Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. Oayeni@witshealth.co.za.
² Department of Radiation Oncology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. Oayeni@witshealth.co.za.
³ Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁴ SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁵ National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa.
⁶ Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁷ Sylvester Comprehensive Cancer Center and Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA.
⁸ Department of Surgery, School of Clinical Medicine, University of KwaZulu-Natal, KwaZulu-Natal, South Africa.
⁹ Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
¹⁰ Department of Surgery, Ngwelezana Hospital, Empangeni and University of KwaZulu-Natal, Empangeni, KwaZulu-Natal, South Africa.
¹¹ Departments of Surgery and Radiation Oncology, Grey's Hospital, University of KwaZulu-Natal, Pietermaritzburg, KwaZulu-Natal, South Africa.
¹² Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.
¹³ Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
¹⁴ Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.
¹⁵ Department of Radiation Oncology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
¹⁶ Division of Medical Oncology, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
¹⁷ School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Parktown, Johannesburg, 2193, South Africa.
¹⁸ Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer, (IARC/WHO), Lyon, France.
¹⁹ Global Health Research Institute, School of Human Development and Health, University of Southampton, Southampton, UK.

Abstract

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.

Keywords: Breast cancer; Chronic conditions; Multimorbidity; South Africa; Survival.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Breast Neoplasms*
Chronic Disease
Diabetes Mellitus* / epidemiology
Female
HIV
HIV Infections* / complications
HIV Infections* / epidemiology
Humans
Hypertension* / epidemiology
Multimorbidity
Obesity / complications
South Africa / epidemiology

Abstract

Publication types

MeSH terms

Grants and funding