Estimated Effects of Potential Interventions to Prevent Decreases in Self-Rated Health Among Breast Cancer Survivors

Purpose: To estimate the effect of hypothetical changes in modifiable predictors on the incidence of fair-to-poor self-rated health (SRH) in breast cancer survivors. Methods: In 2007-2008, we interviewed 832 breast cancer survivors 1 year after diagnosis (baseline) and 1 year later. First, multivariable logistic regression models estimated the association between the predictors (sociodemographic factors, access to medical care, comorbid conditions, psychosocial factors, perceived neighborhood conditions, cancer-related behaviors, clinical factors) and SRH. Second, we estimated the probabilities of fair-to-poor SRH for values of the predictors for each breast cancer survivor. Third, we estimated the population-wide effect of potential changes in modifiable predictors on the incidence of fair-to-poor SRH. Results: A total of 7.6% of participants (92.4% white; mean age, 58.0 years) whose SRH was rated good-to-excellent at baseline reported fair-to-poor SRH 1 year later. The largest potential reduction in incidence of fair-to-poor SRH could be obtained by eliminating surgical side effects (27.8% reduction) and comorbidity (21.8% reduction) and by engaging in any physical activity (19.6% reduction). Conclusions: A significant portion of the decline in SRH can be avoided by reducing surgical side effects, preventing comorbidity, and improving physical activity with the use of evidence-based strategies.