Tailored follow-up care could benefit breast cancer survivors
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Survivors of breast cancer differed greatly in symptom burden after the end of treatment, indicating they could benefit from personalized follow-up care, according to a study presented at ESMO Breast Cancer 2021 Virtual Congress.
“Current standards of follow-up are in general the same for all breast cancer survivors. Our study underlines the importance of more tailored follow-up care,” Kelly de Ligt, PhD, postdoctoral researcher at Netherlands Cancer Institute, told Healio.
As breast cancer outcomes improve with earlier detection and advances in treatment, more importance has been placed on improving quality of life during survivorship, including addressing the multiple symptoms survivors encounter. But, according to de Ligt, previous studies had mainly examined these symptoms independently.
“In reality,” de Light said, “survivors usually experience multiple symptoms that can add up. We therefore studied the overall symptom burden in breast cancer survivors and tried to identify patterns. We believe this may be more relevant, as currently the needs of breast cancer survivors are not fully met and there is a growing demand for personalized follow-up care.”
The analysis included 404 survivors of surgically treated stage I to stage III breast cancer who were 1 year to 5 years out from diagnosis and included in the Netherlands Cancer Registry. De Ligt and colleagues used the EORTC-QLQ-C30 questionnaire to assess survivors’ experiences with fatigue, nausea, pain, shortness of breath, insomnia, constipation, diarrhea, and emotional and cognitive symptoms on a scale of 0 to 100. They then used latent class cluster analyses to reveal patterns of co-existing symptom burden, finding three main subgroups of survivors — low, intermediate or high symptom burden.
These analyses placed 116 survivors (28.7%) in the low symptom group, 224 (55.4%) in the intermediate symptom group and 59 (14.6%) in the high symptom burden group. Survivors with one (RR ratio = 2.75; 95% CI, 1.22-6.19) or more (RR ratio = 9.19; 95% CI, 3.7-22.8) comorbidities appeared significantly more likely to be placed in the high vs. intermediate subgroup.
“We also tried to identify which survivors may be in more need of symptom management,” de Ligt said. “We found that especially patients with comorbidities 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 with the treatment survivors had received. However, because we measured symptom burden and comorbidities at the same time in the study, we cannot draw conclusions from these findings alone.”
Breast cancer survivors in low symptom burden group had a lower symptom burden than 1,300 women in the general Netherlands population.
Survivors of the intermediate subgroup experienced a similar burden as the general population. However, researchers noted the intermediate group’s scores for fatigue, insomnia and cognitive symptoms were worse than those of the general population, with differences of small to medium clinical relevance.
Survivors with high symptom burden had worse symptom burden than the general population, with clinically relevant differences in scores ranging between 15 and 20 percentage points.
Future studies should focus on determining patient and treatment characteristics associated with symptom burden, according to de Ligt.
“Regular assessment with patient-reported outcome measures (PROMs) before the start of treatment for breast cancer and up to several years afterward will allow us to better measure the effect of treatment,” she said. “This regular assessment can also be an important part of regular clinical care in detecting bothersome symptoms in patients. We are currently implementing regular PROM assessment in our daily clinical practice at Netherlands Cancer Institute in Amsterdam.”
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De Ligt K, et al. Abstract 134P_PR. Presented at: ESMO Breast Cancer Virtual Congress 2021; May 5-9, 2021.
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