Abstract:
Background: Breast cancer is the major public health problem throughout the world and it is
the most common cancer in women and in both developed and developing regions. This study
aimed at determining factors that affect longitudinal change of tumor cell and time to death of
breast cancer patients.
Methods: Hospital based retrospective studies were conducted among breast cancer patients.
Both the longitudinal and survival data was extracted from the patient’s chart from the data
record from January 2013 to February 2017. The joint linear mixed model and the Cox
regression model were used to determine factors that affect the longitudinal change of tumor cell
and mortality of breast cancer patients. We analyzed both the separate and joint model of
longitudinal and survival model to determine factors that affect the longitudinal change of tumor
cell and survival time of breast cancer patients.
Results: We compared the separate and joint model by considering their estimates and
corresponding significant values and then we found that joint model having the most significant
and precise estimates. From the survival sub-model result, patients with clinical stage II as
compared to clinical stage I (HR=11.827; CI= 3.018- 46.349), patients with stage III as
compared to clinical stage I (HR=18.619; CI=4.872-71.129), patients who live in rural
(HR=2.750,CI=1.271-5.929), patients whose educational status are secondary
(HR=8.516,CI=3.611-20.008) have significantly increased risk of mortality. From the
longitudinal sub-model, clinical stage II and III, alcohol use and rural residence increases the
progression change of tumor size and also the interaction effect of visit time by age, education by
visit time and stage by visit time contributes to reduce the progression change of the tumor cell.
The results also show that the patient’s survival time is associated with patient-specific tumor
cell fluctuations such that a patient with higher tumor trend is less likely to survive
Conclusion: Having advanced clinical status, secondary and above educational status and rural
residence were found to be the predicting factors for mortality of breast cancer patients. Baseline
tumor cell, clinical stage, alcohol, the interaction effect of visit by age, visit by education and
visit by stage of tumor cell were found to be the predicting factors for longitudinal change of
tumour cell of breast cancer patients.