Older Breast Cancer Survivors May Experience Higher Symptom Burden

Cancer and its treatments were associated with a higher level of actionable symptoms and greater loss of well-being over time in older breast cancer survivors than in comparable noncancer populations, according to a study published in Cancer. 

These data suggest a need for survivorship care guidelines to include clear recommendations and treatment of symptoms among this population. 

“It has been more than a decade since the Institute of Medicine highlighted the unmet needs of cancer survivors, but 50% of survivors still report not getting help to address symptoms,” the authors wrote. 

In this cohort of 750 participants, 50% were eligible breast cancer survivors and the other 50% was a noncancer matched control group. Researchers followed the survivors from presystemic treatment and used data from the frequency matched control group to test whether symptom burden exceeded that generally seen over 36 months. Additionally, they examined whether higher symptom burden decreased physical, emotional, and functional well-being and whether healthy lifestyles moderated symptoms or improved well-being.

Each of the breast cancer survivors reported high baseline symptoms before systemic therapy, and the levels remained high over time. The most notable differences between survivors and controls were cognitive and sleep problems, anxiety, and neuropathy. The adjusted burden score was highest among survivors exposed to chemotherapy, followed by survivors exposed to hormone therapy vs controls (P < .001). The burden score was related to physical, emotional, and functional well-being (e.g., survivors with lower vs higher burden scored had 12.4-point higher physical well-being scores). The composite lifestyle score was not related to symptom burden or well-being, but physical activity was significantly associated with each outcome (P < .005). 

“These findings could inform long-term clinical care to address the persistent effects of treatment because symptoms could affect the completion of hormone therapy,” the authors wrote. “…survivorship care should emphasize screening for and discussion of symptoms, including sleep difficulties, depression, anxiety, pain, and fatigue, especially because these symptoms are actionable.” 

Though healthy lifestyles did not yield benefits in this study, the researchers indicated that lifestyle interventions such as exercise, reductions in sedentary time, and yoga have been shown to increase well-being in other studies, so this topic should not be discounted in survivorship care visits. Moreover, the researchers did not measure all possible symptoms, such as lymphedema, posttraumatic stress disorder, sexual dysfunction, or financial stress, though they suggested that these are important and should be considered in future research. 

In this study, symptom burden was measured as a sum of self-reported symptoms/diseases as follows: pain (yes or no), fatigue (on the Functional Assessment of Cancer Therapy [FACT]-Fatigue scale), cognitive (on the FACT-cognitive scale), sleep problems (yes or no), depression (on the Center for Epidemiology Studies Depression scale), anxiety (on the State-Trait Anxiety Inventory), and cardiac problems and neuropathy (yes or no). Well-being was measured using the FACT-General scale, with scores ranging from 0 to 100. Lifestyle assessments included smoking, alcohol use, body mass index, physical activity, and leisure activities. 

According to the Breast Cancer Research Foundation, the median age of breast cancer is 62 and about one quarter are women between the ages of 75 and 84. As this population continues to age, projections estimate that invasive breast cancer cases will double by 2030 and most of the cases will be in women ages 70-84.

References:

1. Mandelblatt JS, Zhai W, Ahn J, et al. Symptom Burden Among Older Breast Cancer Survivors: The Thinking and Living With Cancer (TLC) Study. Cancer. doi:10.1002/cncr.32663. 

2. Breast Cancer Research Foundation. Breast Cancer in the Elderly: How BCRF Researchers are Treating this Growing Patient Population. Breast Cancer Research Foundation website. Published February 6, 2018. bcrf.org/blog/breast-cancer-elderly-how-bcrf-researchers-are-treating-growing-patient-population. Accessed January 20, 2020.