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

Taiwo Adesoye; Kai-Ping Liao; Susan Peterson; Liang Li; Daria Zorzi; Holly M Holmes; Mariana Chavez-MacGregor; Sharon H Giordano

doi:10.1002/cam4.6394

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

Cancer Med. 2023 Sep;12(17):17740-17752. doi: 10.1002/cam4.6394. Epub 2023 Aug 8.

Authors

Taiwo Adesoye¹, Kai-Ping Liao², Susan Peterson³, Liang Li⁴, Daria Zorzi², Holly M Holmes⁵, Mariana Chavez-MacGregor^{2

6}, Sharon H Giordano^{2

6}

Affiliations

¹ Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
² Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
³ Department of Behavioral Science, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
⁴ Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
⁵ Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Texas Houston McGovern Medical School, Houston, Texas, USA.
⁶ Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.

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.

Grants and funding

P30 CA016672/CA/NCI NIH HHS/United States