09 May Tailored Symptom Management May Be More Appropriate for Breast Cancer Survivors
MedicalResearch.com Interview with:
Kelly de Ligt, PhD
Postdoctoral researcher | Project lead ‘PRO implementation in clinical care’
Psycho Social Research and Epidemiology (PSOE)
Netherlands Cancer Institute – Antoni van Leeuwenhoek
MedicalResearch.com: What is the background for this study?
Response: Health-related Quality of Life (HRQoL) and survivorship has become increasingly important within breast cancer care, as the majority of women survives at least 10 years after breast cancer diagnosis. Breast cancer survivors may experience multiple co-existing symptoms that affect their health-related quality of life (HRQoL). Previous studies have mainly studied these symptoms as separate, independent items. However in reality, 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 in this. 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.
We selected breast cancer survivors from the Netherlands Cancer Registry, which contains comprehensive information about diagnosis and treatment for all cancer patients in the Netherlands. Women who had been surgically treated with or without adjuvant treatment for breast cancer stages I to III and between one and five years after diagnosis were invited to participate in our survey. A total of 404 participating survivors were questioned about their experienced burden for fatigue, nausea, pain, shortness of breath, insomnia, appetite, constipation, diarrhoea, as well as emotional and cognitive symptoms MedicalResearch.com: What are the main findings?
Response: From data-driven analyses, we retrieved three subgroups of breast cancer survivors and compared their experienced symptom burden with a representative sample of 1,300 women of the general population in the Netherlands, who filled out the same questionnaire.
The three subgroups were:
- A subgroup of 30% of survivors with a reported symptom burden that was less severe than that of the general population.
- A subgroup of 55% of survivors who reported a symptom burden similar to the general population, although burden for fatigue, insomnia, and cognitive symptoms was more severe (small to medium clinical relevance).
- A subgroup of only 15% of survivors, their symptom burden was much worse than the general population (medium to large clinical relevance).
MedicalResearch.com: What should readers take away from your report?
Response: Our results show that breast cancer survivors differ widely in the burden of symptoms they experience after the end of treatment. 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.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: We also tried to identify which patients may be in more need of symptom management. 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 patients 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. Future research should focus on determining patient and treatment characteristics that are associated with symptom burden. Regular assessment with Patient Reported Outcome Measures (PROMs) before the start of treatment for breast cancer and afterwards up to several years will allow us to better measure the effect of treatment. Besides, 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 the Netherlands Cancer Insititute in Amsterdam.
ESMO 21 Breast Cancer abstract:
Towards tailored follow-up care for breast cancer survivors: cluster analyses based on symptom burden
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