Table 2. Associations between breast cancer survivorship and adverse mental health outcomes, fatigue, and pain; women diagnosed with breast cancer in the UK between 1988 and 2018, compared to women who never had cancer.
| Breast cancer survivors | Women without cancer | Minimally adjusted associations* | Fully adjusted associations† | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Outcome | No. in analysis | No. of events | PY at risk | No. in analysis | No. of events | PY at risk | HR | 95% CI | p-value | HR | 95% CI | p-value |
| Anxiety | 55,616 | 5,888 | 288,115 | 224,138 | 20,224 | 1,306,784 | 1.35 | 1.31–1.38 | p < 0.001 | 1.33 | 1.29–1.36 | p < 0.001 |
| Depression | 54,073 | 10,175 | 261,081 | 216,355 | 34,558 | 1,202,647 | 1.37 | 1.35–1.40 | p < 0.001 | 1.35 | 1.32–1.38 | p < 0.001 |
| Cognitive dysfunction | 56,052 | 4,368 | 315,453 | 224,444 | 19,845 | 1,385,179 | 1.03 | 1.00–1.06 | p = 0.08 | 1.00 | 0.97–1.04 | p = 0.88 |
| Fatigue | 55,911 | 8,359 | 280,982 | 223,506 | 28,886 | 1,266,975 | 1.31 | 1.28–1.34 | p < 0.001 | 1.28 | 1.25–1.31 | p < 0.001 |
| Pain | 38,771 | 24,522 | 100,312 | 162,037 | 94,171 | 505,451 | 1.28 | 1.26–1.30 | p < 0.001 | 1.22 | 1.20–1.24 | p < 0.001 |
| Sexual dysfunction | 57,444 | 683 | 325,393 | 229,577 | 2,153 | 1,435,837 | 1.34 | 1.24–1.44 | p < 0.001 | 1.27 | 1.17–1.38 | p < 0.001 |
| Sleep disorder | 56,210 | 6,002 | 290,786 | 225,583 | 16,798 | 1,338,065 | 1.71 | 1.66–1.76 | p < 0.001 | 1.68 | 1.63–1.73 | p < 0.001 |
| Opioid analgesics | 52,672 | 17,315 | 248,654 | 213,190 | 44,850 | 1,181,155 | 1.94 | 1.92–1.98 | p < 0.001 | 1.86 | 1.83–1.90 | p < 0.001 |
| Fatal and nonfatal self-harm§ | 32,381 | 157 | 188,102 | 130,590 | 595 | 827,007 | 1.16 | 0.99–1.36 | p = 0.07 | 1.15 | 0.97–1.36 | p = 0.11 |
95% CI, 95% confidence interval; BMI, body mass index; CPRD, Clinical Practice Research Datalink; HR, hazard ratio; ONS, Office for National Statistics; PY, person-years.
* Women with a breast cancer diagnosis were matched with women who never had cancer on age (within a 3-year range), primary care practice (proxy of socioeconomic status), and eligibility for data linkage (to avoid loss of precision in subset analyses). No other variables were adjusted for in these analyses.
† Further adjusted for diabetes, BMI (restricted cubic spline), and smoking and drinking status.
§ Patients in England only, as the analysis was restricted to CPRD GOLD primary care data linked to the Hospital and Episode Statistics and ONS mortality data.