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The Intersection of Cancer and Aging: Establishing the Need for Breast Cancer Rehabilitation

¹ Division of Clinical Epidemiology, Center for Clinical Epidemiology and Biostatistics; ² Division of Diabetes and Endocrinology; ³ Abramson Cancer Center, University of Pennsylvania School of Medicine; ⁴ School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania; and ⁵ Department of Family and Preventive Medicine, Health Research Center, University of Utah School of Medicine, Salt Lake City, Utah

Requests for reprints: Kathryn H. Schmitz, Division of Clinical Epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, 921 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104. Phone: 215-898-6604; Fax: 215-573-2265. E-mail: schmitz{at}mail.med.upenn.edu

The increasing success of treatments for common cancers has resulted in growing awareness of the unique health care needs of cancer survivors. Cancer treatments can be toxic and have long-lasting effects on health, potentially accelerating the aging process and producing associated declines in physical function. In this synthesis of the literature, we critically examine the strength of existing evidence that breast cancer diagnosis and treatment are associated with a disproportionate decline in physical function compared with the effects of living without cancer for the same number of years. There is some observational epidemiologic evidence that women treated for breast cancer report greater declines in physical function than their peers. Discerning the factors associated with such declines and their clinical significance remains to be addressed. Physiologic, psychological, and behavioral changes associated with both aging and cancer treatment are reviewed. Parallels are proposed between existing preventive and rehabilitative programs and possibilities for similar interventions aimed at preventing, reversing, or halting declines in physical function in cancer survivors. Finally, a program of research is proposed to evaluate whether there is some subset of breast cancer survivors for whom prevention or rehabilitation of functional status declines is needed, as well as development of targeted, mechanistically driven interventions. (Cancer Epidemiol Biomarkers Prev 2007;16(5):866–72)