Patient-reported outcomes in older breast cancer survivors with and without prior chemotherapy treatment

Abstract

Background: Little is known about long-term treatment-related symptoms in older breast cancer survivors. We characterized long-term patient-reported symptoms and examined factors associated with the presence and severity of symptoms, and symptom interference with daily activities.

Methods: Texas Cancer Registry (TCR) Medicare linkage data was used to identify breast cancer patients age 65 and older with local/regional stage disease diagnosed between 2012-2013. Symptom burden was assessed using breast-specific items from the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE™). Demographic and clinical data also were collected. Logistic regression models were used to assess the association between symptom burden and respondent sociodemographic and clinical characteristics.

Results: Of 4448 eligible patients, 1594 (response-rate 35.8%) completed questionnaires. Of these, 1245 eligible respondents were included in the analysis based on self-reported data. Median time from diagnosis to survey completion was 68 months (IQR: 62-73). Most frequently reported symptoms were fatigue/lack of energy (76.8%), aching muscles (72.1%) and aching joints (72.5%). Receipt of chemotherapy was associated with higher symptom burden. Patients treated with adjuvant chemotherapy had higher risk of numbness/tingling (OR: 3.16; 95% CI: 2.36-4.24), hair loss (OR: 2.72; 95% CI: 2.05-3.60), and fatigue/lack of energy (OR: 1.80; 95% CI: 1.29-2.52). Similarly, patients who received chemotherapy were more likely to report the majority of symptoms as moderate to severe and as interfering with daily activities.

Conclusion: Receipt of chemotherapy is associated with significant symptom burden more than 5 years after breast cancer treatment. Long-term chemotherapy impact should be discussed with patients in a shared-decision making process and approaches to symptom management during survivorship care are needed.

Keywords: breast cancer; geriatric oncology; survivorship.

FIGURE 1

Selection of study participants.

FIGURE 2

Patient‐reported symptoms by receipt of chemotherapy. (A) Presence of symptoms^#. ^#For all comparisons p ≤ 0.05. (B) Presence of moderate to severe symptoms^%. ^%For all comparisons p < 0.01 except arm/leg swelling (p = 0.078) and hot flashes (p = 0.22). (C) Symptom interference with daily activities^#. ^#For all comparisons p < 0.05.

FIGURE 3

Logistic regression models of breast cancer patient reported symptoms and association with receipt of chemotherapy. (A) Presence of symptoms. (B) Presence of moderate to severe symptoms. (C) Symptom interference with daily activities.