Hot flashes, fatigue, back and joint pain, and anxiety are some of the symptoms and concerns frequently reported by early-stage breast cancer survivors, according to results from a study of 98 women with low-risk stage I/II estrogen/progesterone-positive, HER2/neu-negative cancers. These findings were presented by Jessica Schumacher, PhD, MS, Associate Professor, Surgery, University of Wisconsin School of Medicine and Public Health, Madison, during the American Society of Breast Surgeons 22nd Annual Meeting.
According to Dr Schumacher, of the 3.5 million breast cancer survivors in the United States currently receiving follow-up care for detection of recurrence, symptom management, and treatment adherence, approximately two-thirds were diagnosed at an early stage and are at low risk for dying from their disease. Although many studies have reported on the symptom experience of survivors diagnosed with later-stage breast cancer, very few studies have focused on the post-treatment concerns of low-risk breast cancer survivors, she said.
To assess how these symptoms interfered with the quality of life of survivors with early-stage breast cancer following active treatment, Dr Schumacher and colleagues surveyed patient-reported outcomes in women treated at the University of Wisconsin Breast Center. Survivors were eligible to participate if they had a history of stage I/II estrogen or progesterone receptor–positive, HER2/neu-negative breast cancer, were 6 months to 5 years postdiagnosis, were cancer-free, and had not received chemotherapy. Survey topics were shaped, in part, by the American Society of Clinical Oncology and the American Cancer Society Survivorship Care Guidelines.
The mean age of women surveyed was 61.3 years, and the average time from diagnosis was 2.5 years (range, 6 months-5 years). Lumpectomies had been performed in 71.3% of patients and mastectomies in 28.7%. Overall, 71% of patients were treated with breast-conserving surgery with radiotherapy, and 87.2% received endocrine therapy.
Clinically significant concerns were reported by 86.7% of women, with 38.8% citing 1 or 2 concerns, and 47.9% citing ≥3 concerns. Symptoms or concerns were absent altogether in 6.4% of women and clinically significant ones were absent in 13.8%.
“Physicians should be aware that breast cancer survivorship comes with a significant ongoing burden of symptoms, even for those who experience a mild form of the disease and do not receive aggressive treatment,” Dr Schumacher said.
Among patients reporting clinically significant symptoms or concerns, approximately 50% reported hot flashes, approximately 40% reported fatigue, and >30% reported back pain, joint pain, and anxiety. Headaches and difficulty taking endocrine therapy were reported by approximately 25% of respondents. Bone pain, new breast symptoms, cough, arm swelling, and extremity weakness were also relatively common complaints. In addition, some patients reported feeling anxious about the possibility of new symptoms, such as breast pain, that might indicate disease recurrence.
Dr Schumacher said that with approximately 50% of survivors reporting ≥3 concerns, it is likely that regular time-limited follow-up visits will not fully reveal them. For example, the complex and sensitive nature of concerns regarding sexual health were reflected in the fact that while on average only 2.0% of patients avoided responding to specific topics, 14.3% skipped sexual health questions, more than any other topic.
“This represents a clear opportunity to improve survivorship care,” Dr Schumacher stated.
“Our experience in developing this study suggests that a self-reported, pre-appointment assessment tool, such as the one used here, may be useful in helping physicians appropriately address patient concerns. It may alert them to symptoms with potential health implications and help physician visits focus on symptoms that are important to patients, providing a stimulus for meaningful discussions,” Dr Schumacher concluded.