Predicting All-Cause Mortality in Women With and Without Breast Cancer Using the Schonberg Index: A Women’s Health Initiative Study

Rebecca A. Nelson, Enrique Soto-Perez-de-Celis*, Rowan T. Chlebowski, Mara Schonberg, Joanne Mortimer, Kathy Pan, Lifang Hou, Marian L. Neuhouser, Kerryn W. Reding, Nazmus Saquib, Jean Wactawski-Wende, Emily Wolfson, Mina S. Sedrak, Laura Kruper

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: When treating older women with breast cancer, life expectancy is an important consideration. ASCO recommends calculating 10-year mortality probabilities to inform treatment decisions. One useful tool is the Schonberg index, which predicts risk-based all-cause 10-year mortality. We investigated the use of this index in women aged $65 years with breast cancer in the Women’s Health Initiative (WHI). Methods: We calculated 10-year mortality risk scores for 2,549 WHI participants with breast cancer (“cases”) and 2,549 age-matched breast cancer–free participants (“controls”) using Schonberg index risk scoring. Risk scores were grouped into quintiles for comparisons. Risk-stratified observed mortality rates and 95% confidence intervals were compared across cases and controls. Observed 10-year mortality rates in cases and controls were also compared with Schonberg index–based predicted 10-year mortality rates. Results: Compared with controls, cases were more often white (P5.005), had higher income and education levels (P,.001 for both), more often lived with their husband/partner (P,.001), scored higher on subjective health/happiness (P,.001), and needed less assistance in activities of daily living (P,.001). Participants with breast cancer had similar risk-stratified 10-year mortality rates compared with controls (34% vs 33%, respectively). Stratified results showed that cases had slightly higher mortality rates than controls in the lowest risk quintile and lower mortality rates in the 2 highest risk quintiles. Observed mortality rates in cases and controls were similar to Schonberg index–predicted mortality, with model c-indexes of 0.71 and 0.76, respectively. Conclusions: Among women aged $65 years with incident breast cancer, the Schonberg index–based risk-stratified 10-year mortality rates were similar to those in women without breast cancer, demonstrating a similar performance of the index among both populations. Along with other health measures, prognostic indexes can help predict survival among older women with breast cancer and support geriatric oncology guidelines that promote using life expectancy calculation tools for shared decision-making.

Original languageEnglish (US)
Pages (from-to)636-644
Number of pages9
JournalJNCCN Journal of the National Comprehensive Cancer Network
Volume21
Issue number6
DOIs
StatePublished - Jun 2023

Funding

Funding: Research reported in this publication was supported by the National Heart, Lung and Blood Institute of the National Institutes of Health under award numbers N01WH22110, 24152, 32100-2, 32105-6, 32108-9, 32111-13, 32115, 32118-32119, 32122, 42107-26, 42129-32, and 44221.

ASJC Scopus subject areas

  • Oncology

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