Breast Cancer Survivors May Experience Symptom Burden Years After Treatment

More than half of long-term breast cancer survivors experience medium to high symptom burden years after treatment, according to findings from a recent study.

A study from Cancer found that long-term survivors of stages 1 to 3 breast cancer who were younger and had received systemic treatment were more likely to experience higher symptom burden, or late effects (LEs).

The study authors determined that for younger survivors of breast cancer, “treatment-induced premature menopause, limited coping skills concerning serious illness, and higher expectation of maintaining family and work life participation” could contribute towards higher symptom burden.

The symptoms analyzed in the study were pain, arm problems, breast problems, neuropathy (nerve damage, causing pain and numbness in hands and feet), sleep disturbances, cognitive dysfunction, emotional dysfunction (anxiety and depression), sexual dysfunction, fatigue and fear of cancer recurrence.

“In the present study exploring total burden of LEs eight years after early-stage breast cancer, more than half of breast cancer survivors reported medium or high symptom burden,” the study authors wrote.

“Both sociodemographic, cancer-related, and lifestyle variables were associated with higher levels of symptom burden. Breast cancer survivors with higher symptom burden had poorer general functioning and a larger proportion held disability pension compared with breast cancer survivors with low symptom burden,” they wrote.

The study included 2,803 women from Norway, with a mean age of 60 years and a mean of eight years after receiving a diagnosis. Participants in the study were divided into three subgroups: low symptom burden, medium symptom burden and high symptom burden.

Participants within the low symptom burden subgroup experienced low prevalence of all LEs except for sexual dysfunction and fear of cancer recurrence.

The authors reported that those in the medium symptom burden subgroup had a “high prevalence of pain (62%), cognitive dysfunction (67%), chronic fatigue (49%), sleep disturbances (51%), emotional dysfunction (46%), and fear of recurrence (68%).” Participants in this subgroup had a lower prevalence of arm problems (32%) and breast problems (21%), with neuropathy (20%).

Participants in the high symptom burden subgroup had high prevalence of all ten LEs, from 100% for pain to 36% for sexual dysfunction.

“Fear of cancer recurrence was prevalent in all subgroups (>40%), although significantly lower among breast cancer survivors in the subgroup with low compared with the subgroups with medium and high symptom burden,” the authors wrote.

Reasons for higher symptom burden was examined in the study, in which the authors found that younger age, having previously received chemotherapy and endocrine therapy, higher BMI and physical inactivity were all factors related to medium and high symptom burdens.

In particular, the authors noted that short education, axillary dissection (removing affected underarm lymph nodes) and adjuvant chemotherapy (chemotherapy after initial treatment) contributed towards high symptom burden.

According to the study, the majority of the participants had previously received treatment with radiotherapy (80%), sentinel node biopsy (63%) and breast-conserving therapy (59%). They also noted that more than half of the participants received both chemotherapy and endocrine therapy.

The study authors also noted that the overall LEs reported by more than 20% of the breast cancer survivors. The most prevalent LEs included 56% for fear of cancer recurrence, 47% for pain, 43% for cognitive dysfunction, 34% for sleep disturbances, 32% for arm problems and 32% for fatigue.

“Our finding, that almost one in five breast cancer survivors experienced a high symptom burden, was in line with results from studies focusing on the first five years of survivorship, indicating that the overall prevalence of high symptom burden may not decrease with time since diagnosis,” the authors wrote in the study.

“This study underlines the importance of tailored survivorship care, as opposed to one-size-fits all approach,” wrote the authors.

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