As breast cancer becomes an increasingly treatable disease, clinicians should provide personalized follow-up care to address varying burdens of symptoms up to 5 years after diagnosis.
Because breast cancer survivors can have differing burdens of symptoms following the end of treatment, new research suggests that individualized follow-up care is necessary to address unmet needs in this patient population.
Breast cancer is becoming an increasingly curable disease, according to a press release from the European Society for Medical Oncology, with more than 70% of women surviving at least 10 years following their diagnosis due to improved early detection and treatment options. Therefore, the quality of life after cancer is therefore becoming an important aspect of the patient journey, although investigators said it may be inadequately addressed by current standards of follow-up care.
“Follow-up programs are different in each country. In the Netherlands, for instance, breast cancer survivors have an annual visit with their treating physician for a follow-up period of 5 years, or 10 years if they are young,” explained lead author Kelly de Ligt, MSc, of the Netherlands Cancer Institute in Amsterdam, in the press release. “Previous studies had assessed side effects experienced after the end of treatment as independent items, but in reality, survivors usually experience multiple symptoms that can add up and weigh heavily on their daily life.”
The researchers selected women who had been surgically treated with or without adjuvant treatment for breast cancer stages 1 through 3 between 1 and 5 years prior to the study. A total of 404 participating survivors were questioned about their experienced burden for fatigue, nausea, pain, shortness of breath, insomnia, appetite, constipation, diarrhea, and emotional and cognitive symptoms.
By analyzing their answers, the investigators identified 3 main subgroups of breast cancer survivors experiencing low, intermediate, and high symptom burdens respectively. De Ligt explained that almost one-third of patients belonged to the low-burden group, in which women were less affected compared to the average in a representative sample of 1300 women in the Netherlands.
“I was pleasantly surprised to find that so many survivors were doing as well or even better than the average Dutch woman,” de Ligt said in the press release.
Furthermore, 55% of study participants were in the intermediate-burden subgroup, which had similar results to the general population. However, these women had slightly worse scores for fatigue, insomnia, and cognitive symptoms. Despite these positive findings, de Ligt said she was alarmed by the results observed in the high-burden subgroup.
“This was the smallest subgroup, only 15% of our population, but nonetheless, 1 in 6 women in our study had worse scores than the general population for all symptoms—and the differences, ranging between 15 and 20 percentage points, were large enough to be considered not just statistically significant, but clinically relevant as well,” de Ligt said in the press release.
These findings confirm the need for personalized approaches to follow-up care for cancer survivors, de Ligt said. Some patients require special attention as late as 5 years after diagnosis, according to the study.
In addition to these findings, the study results found that patients with comorbidities such as heart disease and diabetes were more likely to experience a high symptom burden. This association was especially strong, de Ligt said, although she noted that because the investigators simultaneously measured symptom burden and comorbidities, they could not draw conclusions from these findings alone.
“Future research should attempt to measure patients’ health-related quality of life through Patient Reported Outcome Measures (PROMs) before the start of treatment for breast cancer and afterwards to allow us to measure the effect of the therapy,” de Ligt said in the press release.
Personalized follow-up care needed to address varying health burdens in breast cancer pts [news release]. EurekAlert; May 3, 2021. https://www.eurekalert.org/pub_releases/2021-05/esfm-pfc043021.php. Accessed May 10, 2021.