| Summary: | 碩士 === 國立臺北護理健康大學 === 健康事業管理研究所 === 103 === Abstract
Backgrounds
Breast cancer is the most common cancer in women worldwide. There are an estimated 5.8 million breast cancer survivors in the world. Breast cancer incidence increases with age, as does the incidence of many other chronic diseases, such as diabetes, hypertension, and cardiovascular disease (CVD). Hence, many breast cancer patients have one or more comorbid conditions at diagnosis. Comorbidities have been shown to influence cancer treatment decisions and short- and long-term survival. In the United States cancer patients death rate continues to decrease by 1.5% per year. In the next 10 years, various cancer survivors will continue to increase by about 30% . By 2020, two-thirds of cancer survivors age will be at least 65 years old, this trend of retaining cancer patients longer time of survival, will pose new challenges.
Most previous studues of breast cancer comorbidities were based on cross-sectional design. The long-term data of the dynamics analysis will help to investigate the long-term changes in breast cancer -related comorbidities and their subsequent impacts.The current research of comorbidities patterns is still relatively inadequate. However, the potential long-term data analysis methods, such as the development and breakthrough of the transition probability-provides us with an opportunity for further research.In accordance, this present study is to investigate the use of long-term dynamic view on the long-term effects of breast cancer comorbidity.
Methods
Patients diagnosed with breast cancer in 2000 were retrieved from the Taiwan`s National Health Insurance Research Database(NHIRD) in 1997~2010 year. The incident cases of breast cancer in 2000 were continuously tracked down for a decade as an analytical generation. Latent transition analysis(LTA) was use to analyze long term comorbidity patterns.
Results
The results are divided into five main points：(1) latent structure underlying the comorbidity of breast cancer were subdivided into three main types:highly comorbidity patteren, moderate comorbidity patteren, and low comorbidity patteren. The patteren variesd by different age group. (2) comorbidity patterens have the potential diffencet types. Diabetes mellitus is an important comorbidity index across different age group. The presence of diabetes mellitus increase the chances of other linked comorbidities generated, and thus, it becomes the highly comorbidity patterens. (3)In the long term structural shift, breast cancer comorbidities were classified into five kinds of potential transfer class groups. For example, overall the breast cancer patients, the performance of each type of CT1:persistent diabetes mellitus was closely associated with hypertention and high cholesterol; CT2: persistent hypertention was closely associated with cardiovascular heart disease; CT3: sustained less frequent comorbidities; CT4: hypertention as it`s core which was usually accompanied with cardiovascular heart disease in the early stage , and then later advancing to diabetes mellitus as it`s core, which was usually accompanied with hypertension and high cholesterol; CT5: early stage with less frequent comorbidity and then later transferred to the core of diabetes mellitus comorbid group after a certain amount of time.Therefore, different types of transition group were able to reflect various comorbidities in the long-term developmental process. (4)Among the long-term transfer performance type, breast cancer patients with potential class group may transfer from medium to high comorbid conditions. In the past decade, stroke and congestive heart failure(CHF) had the highest cumulative incidence rate. However, the trajectory of each class transferred into a highly comorbid group also had the second highest of occurrence rate. (5) finally, through years of longitudinal transition probabilities and calculate the potential class group suffered a stroke and heart failure runs through the odds ratio results, breast cancer patients with presented continued highly comorbidities or hypertension as it`s core ,usually worsen with age as Diabetes Mellitus becomes it`s core group of comorbidity. It`s usually followed by increased incidence of subsequent stroke and CHF.
Conclusions
Overall, the links between comorbidities and breast cancer are quite complex.This study and application of Latent Transition Analysis(LTA) provides the potential class of types specific breast cancer comorbidities, with five well-identified different long term transition structures. And this studt also concluded that structural change in the development of different comorbidity patterens are associated with the risk of stroke and CHF, which also play an important role in providing health care for caregivers to develop a reference guide for different risk groups.
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