Symptom Burden in Older Breast Cancer Survivors Highlights Need for Surveillance

Older breast cancer survivors experienced a higher level of actionable symptoms and greater loss of well-being over time, highlighting the need for surveillance and intervention, according to findings from a study published in Cancer.

“Many of the nearly 4 million US breast cancer survivors report one or more symptoms commonly associated with cancer, including cardiotoxic effects, peripheral neuropathy, cognitive problems, fatigue, anxiety, depression and sleep disturbances,” the researchers explained. “Older women (aged 60 years or older) constitute the largest segment of breast cancer survivors. These older survivors may be especially vulnerable to a high symptom burden and their symptoms tend to affect functioning, given comorbidities and aging.”

In this study, the researchers used data from the Thinking and Living With Cancer (TLC) cohort of older breast cancer survivors who were followed from pre-systemic treatment for 36 months, and also included data from a frequency-matched noncancer control group to determine whether symptom burden in older survivors exceeded that seen over 36 months compared with the noncancer population. In turn, they also evaluated whether higher symptom burden decreased physical, emotional and functional well- being and whether healthy lifestyles moderated symptoms or improved well-being.

Symptom burden was measured as the sum of self-reported symptoms, like pain, fatigue, cognitive, sleep problems, depression, anxiety and cardiac problems and neuropathy. Well-being was measured on a scale of zero to 100. Lifestyle factors included smoking, alcohol use, body mass index, physical activity and leisure activities.

Participants were aged 60 to 98 years, and there was a high rate of all symptoms at baseline before systemic therapy. Over time, survivors who received chemotherapy tended to have the highest levels of peripheral neuropathy, depression and pain, while those exposed to either chemotherapy and/or hormone therapy demonstrated a pattern of higher fatigue, sleep disturbance and cardiovascular problems compared with the noncancer population over time.

The researchers found that the most notable differences between survivors and the noncancer population were cognitive and sleep problems, anxiety and neuropathy.

The adjust burden score was highest in those who were treated with chemotherapy, followed by survivors who underwent hormone therapy, compared with the noncancer population. The researchers found this score was associated with physical, emotional and functional well-being, meaning survivors who reported lower burden had higher physical well-being.

“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 researchers wrote.

The composite lifestyle score was not related to symptom burden or well-being, but physical activity was significantly associated with each outcome.

As a result, the researchers noted that hospital system interventions, like chart reminders, could help cancer-related symptom screening. Moreover, professional guidelines could also help to emphasize the need for symptom recognition and management.

“Future research is needed to understand factors that contribute to resilience or vulnerability to a high symptom burden and functional decline. Until then, survivorship care guidelines should include clear recommendations for surveillance and treatment of symptoms among older survivors,” the researchers concluded.