Symptom Burdens for Breast Cancer Survivors Largely Variable, Indicating Need for Personalized Care

The symptom burdens experienced by breast cancer survivors after the end of treatment are widely variable, according to a study presented at the ESMO Breast Cancer 2021 Virtual Congress. This has revealed an unmet need for personalized follow-up care addressing the experiences of individual patients, according to the researchers.

“Follow-up programs are different in each country,” said Kelly de Ligt, PhD, in a press release. “In the Netherlands, for instance, breast cancer survivors have an annual visit with their treating physician for a follow-up period of 5 years, or 10 years if they are young. Previous studies had assessed side-effects experienced after the end of treatment as independent items, but in reality, survivors usually experience multiple symptoms that can add up and weigh heavily on their daily life. We wanted to measure the overall burden on their health-related quality of life and see if any patterns emerged that would better inform us on which individuals require active symptom management.”

The researchers selected 404 participants who had been surgically treated with or without adjuvant treatment for breast cancer stages I to III that were between 1- and 5-years post-diagnosis from the Netherlands Cancer Registry. These patients were questioned about their experienced burden for fatigue, nausea, pain, shortness of breath, insomnia, appetite, constipation, and diarrhea, as well as emotional and cognitive symptoms.

Analysis of these responses allowed the researchers to organize breast cancer survivors into 3 primary categories: low, intermediate, and high symptom burdens.

“In the low-burden group, to which almost a third of patients belonged, women were less affected compared to the average found among a representative sample of 1300 women of the general population in the Netherlands, who filled out the same questionnaire," de Ligt said in the release. “I was pleasantly surprised to find that so many survivors were doing as well or even better than the average Dutch woman.”

Fifty-five percent of study participants were classed in the intermediate-burden subgroup, which had similar results to the general population, though their scores for fatigue, insomnia, and cognitive symptoms were slightly worse. The high-burden subgroup, according to the investigators, confirmed the necessity for personalized approaches to the follow-up of cancer patients, some of whom still required specialized treatment up to 5 years after diagnosis.

“This was the smallest group, only 15% of our population, but nonetheless, 1 in 6 women in our study had worse scores than the general population for all symptoms—and the differences, ranging between 15 and 20 percentage points, were large enough to be considered not just statistically significant, but clinically relevant as well,” de Ligt said in the release.

The study also found that patients with comorbidities such as heart disease and diabetes were more likely to experience a high symptom burden.

“This association was so strong in our analysis that we were not able to link the level of symptom burden patients reported with the type of therapy they had received.,” de Ligt said in the release. “However, because we measured symptom burden and comorbidities at the same time in the study, we cannot draw conclusions from these findings alone. Future research should attempt to measure patients' health-related quality of life through Patient Reported Outcome Measures (PROMs) before the start of treatment for breast cancer and afterwards to allow us to measure the effect of the therapy.”

REFERENCE

Personalised follow-up care needed to address varying health burdens in breast cancer pts [news release]. EurekAlert; May 3, 2021. Accessed May 4, 2021. https://eurekalert.org/pub_releases/2021-05/esfm-pfc043021.php