The multimorbidity profile of South African women newly diagnosed with breast cancer
Corresponding Author
Oluwatosin A. Ayeni
Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, Gauteng, South Africa
SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Pediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
Correspondence to: Dr Oluwatosin A. Ayeni, E-mail: [email protected]Search for more papers by this authorShane A. Norris
Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, Gauteng, South Africa
SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Pediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
Search for more papers by this authorMaureen Joffe
Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, Gauteng, South Africa
SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Pediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
South Africa Medical Research Council Common Epithelial Cancers Research Centre, University of Witwatersrand, Johannesburg, Gauteng, South Africa
Search for more papers by this authorHerbert Cubasch
Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, Gauteng, South Africa
South Africa Medical Research Council Common Epithelial Cancers Research Centre, University of Witwatersrand, Johannesburg, Gauteng, South Africa
Department of Surgery, Chris Hani Baragwanath Academic Hospital and Faculty of Health Sciences, University of Witwatersrand, Johannesburg, Gauteng, South Africa
Search for more papers by this authorSarah Nietz
Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, Gauteng, South Africa
Department of Surgery, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of Witwatersrand, Johannesburg, Gauteng, South Africa
Search for more papers by this authorInes Buccimazza
Department of Surgery and Oncology, Inkosi Albert Luthuli Central Hospital, Durban and Ngwelezane Hospital, University of KwaZulu Natal, Empangeni, KwaZulu Natal, South Africa
Search for more papers by this authorUrishka Singh
Department of Surgery and Oncology, Inkosi Albert Luthuli Central Hospital, Durban and Ngwelezane Hospital, University of KwaZulu Natal, Empangeni, KwaZulu Natal, South Africa
Search for more papers by this authorSharon Čačala
Department of Surgery and Oncology, Grey's Hospital, University of KwaZulu Natal, Pietermaritzburg, KwaZulu Natal, South Africa
Search for more papers by this authorLaura Stopforth
Department of Surgery and Oncology, Grey's Hospital, University of KwaZulu Natal, Pietermaritzburg, KwaZulu Natal, South Africa
Search for more papers by this authorWenlong C. Chen
National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Search for more papers by this authorValerie A. McCormack
Section for Environment and Radiation, International Agency for Research on Cancer, Lyon, France
Search for more papers by this authorDaniel S. O'Neil
Department of Medicine, University of Miami Miller School of Medicine, Miami, FL
Search for more papers by this authorJudith S. Jacobson
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
Search for more papers by this authorAlfred I. Neugut
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY
Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
Search for more papers by this authorPaul Ruff
Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, Gauteng, South Africa
South Africa Medical Research Council Common Epithelial Cancers Research Centre, University of Witwatersrand, Johannesburg, Gauteng, South Africa
Division of Medical Oncology, Department of Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, Gauteng, South Africa
Search for more papers by this authorLisa K. Micklesfield
Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, Gauteng, South Africa
SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Pediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
Search for more papers by this authorCorresponding Author
Oluwatosin A. Ayeni
Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, Gauteng, South Africa
SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Pediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
Correspondence to: Dr Oluwatosin A. Ayeni, E-mail: [email protected]Search for more papers by this authorShane A. Norris
Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, Gauteng, South Africa
SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Pediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
Search for more papers by this authorMaureen Joffe
Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, Gauteng, South Africa
SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Pediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
South Africa Medical Research Council Common Epithelial Cancers Research Centre, University of Witwatersrand, Johannesburg, Gauteng, South Africa
Search for more papers by this authorHerbert Cubasch
Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, Gauteng, South Africa
South Africa Medical Research Council Common Epithelial Cancers Research Centre, University of Witwatersrand, Johannesburg, Gauteng, South Africa
Department of Surgery, Chris Hani Baragwanath Academic Hospital and Faculty of Health Sciences, University of Witwatersrand, Johannesburg, Gauteng, South Africa
Search for more papers by this authorSarah Nietz
Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, Gauteng, South Africa
Department of Surgery, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of Witwatersrand, Johannesburg, Gauteng, South Africa
Search for more papers by this authorInes Buccimazza
Department of Surgery and Oncology, Inkosi Albert Luthuli Central Hospital, Durban and Ngwelezane Hospital, University of KwaZulu Natal, Empangeni, KwaZulu Natal, South Africa
Search for more papers by this authorUrishka Singh
Department of Surgery and Oncology, Inkosi Albert Luthuli Central Hospital, Durban and Ngwelezane Hospital, University of KwaZulu Natal, Empangeni, KwaZulu Natal, South Africa
Search for more papers by this authorSharon Čačala
Department of Surgery and Oncology, Grey's Hospital, University of KwaZulu Natal, Pietermaritzburg, KwaZulu Natal, South Africa
Search for more papers by this authorLaura Stopforth
Department of Surgery and Oncology, Grey's Hospital, University of KwaZulu Natal, Pietermaritzburg, KwaZulu Natal, South Africa
Search for more papers by this authorWenlong C. Chen
National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Search for more papers by this authorValerie A. McCormack
Section for Environment and Radiation, International Agency for Research on Cancer, Lyon, France
Search for more papers by this authorDaniel S. O'Neil
Department of Medicine, University of Miami Miller School of Medicine, Miami, FL
Search for more papers by this authorJudith S. Jacobson
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
Search for more papers by this authorAlfred I. Neugut
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY
Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
Search for more papers by this authorPaul Ruff
Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, Gauteng, South Africa
South Africa Medical Research Council Common Epithelial Cancers Research Centre, University of Witwatersrand, Johannesburg, Gauteng, South Africa
Division of Medical Oncology, Department of Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, Gauteng, South Africa
Search for more papers by this authorLisa K. Micklesfield
Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, Gauteng, South Africa
SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Pediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
Search for more papers by this authorAbstract
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.
Abstract
What's new?
Multimorbidity in women with breast cancer increases with age and may influence treatment decisions and outcome. The authors find that in South Africa 44%, of women newly diagnosed with breast cancer also suffered from other chronic conditions, most prevalently obesity, hypertension, HIV and diabetes. Asian and white women were less likely to present with multimorbidity when compared to black women, but multimorbidity was more common in women with higher socioeconomic status. The authors propose to evaluate the effect of multimorbidity on the South African health system and its impact on scarce health care resources.
Open Research
Data availability
Data for our study contain confidential patient information. Data supporting the results reported in this article may be requested from the corresponding author.
Supporting Information
| Filename | Description |
|---|---|
| ijc32727-sup-0001-Tables.pdfPDF document, 142.9 KB | Table S1 Showing the frequency of chronic conditions (Obesity, self-reported hypertension, diabetes, cerebrovascular disease, asthma/COPD, HIV and self-reported prior tuberculosis) in South African women newly diagnosed with breast cancer Table S2: Showing the pattern and combination of chronic conditions (Obesity, self-reported hypertension, diabetes, cerebrovascular disease, asthma/COPD, HIV and self-reported prior tuberculosis) in South African women newly diagnosed with breast cancer Table S3: Pooled bivariate association of sociodemographic characteristics and chronic condition risk in women newly diagnosed with breast cancer in South Africa |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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