Breast Cancer Survivorship Rarely Easy, Even With Early Stage, Low-Risk Disease

By Megan Brooks

May 04, 2021

NEW YORK (Reuters Health) - Women often have ongoing symptoms and concerns following treatment for early-stage, low-risk breast cancer, according to a new study.

"The study findings underscore that survivorship is rarely easy, regardless of the patient's care path and recurrence risk," Dr. Jessica Schumacher of the University of Wisconsin-Madison told Reuters Health by email.

"It is important that providers comprehensively assess symptoms to ensure concerns are addressed, either by providing care directly, referring care to other providers, or providing reassurance to their patients that concerning symptoms are not indicative of an underlying problem," she advised.

Dr. Schumacher discussed her research at the American Society of Breast Surgeons (ASBrS) virtual annual meeting.

About two-thirds of women diagnosed with breast cancer in the United States are diagnosed with low-risk disease and thus face a low-risk of recurrence.

Little is known, however, about ongoing symptoms and concerns experienced by these women because the literature to date has focused on women diagnosed with higher-risk disease, Dr. Schumacher explained.

"This study used a comprehensive survey of symptoms and concerns that reflect key survivorship domains to assess ongoing symptoms and concerns experienced by women diagnosed with low-risk breast cancer," she said.

The study examined responses from 98 women at a single center with an average age of 61 years and a history of stage I-II estrogen- or progesterone-receptor-positive, HER2neu-negative breast cancer, who were six months to five years from diagnosis, were cancer free, and did not receive chemotherapy; 71.3% of the women had undergone lumpectomy, while 28.7% had been treated with mastectomy.

"Despite not having undergone systemic therapies such as chemotherapy, women diagnosed with low-risk breast cancer following surgery reported experiencing a high burden of symptoms and concerns, with nearly half of women reporting three or more clinically significant concerns," Dr. Schumacher told Reuters Health.

Hot flashes (due to endocrine therapy), fatigue, back and joint pain, and anxiety were among the most common issues cited on the self-reported assessment, followed by issues taking endocrine therapy, headaches, bone pain, arm swelling, and new breast symptoms potentially indicative of a recurrence.

"The prevalence of symptoms and concerns was higher than expected. These symptoms have important implications for quality of life after cancer treatment," Dr. Schumacher said.

"A pre-visit self-assessment tool measuring symptoms and concerns may be helpful in identifying concerns that may not otherwise be recognized given that follow-up physician visits are often subject to time limitations that make in-depth discussion of a full range of issues difficult," she suggested.

Dr. Charles L. Shapiro, director of Breast Cancer Translational Research at Mount Sinai Health System, in New York City, told Reuters Health by email that the "high" prevalence of symptoms and symptom burden in these survivors, none of whom had chemotherapy, is "not surprising."

Dr. Shapiro, who wasn't involved in the study, also pointed out that "the limitations of this study, besides the small size of sample, are the lack of some baseline assessment of women (e.g., what were the symptoms just after they were diagnosed?)."

Finally, he noted that "the American College of Surgeons, and other policy-making organizations, as part their accreditation process, require that individuals with cancer undergo some type of distress screening periodically precisely to identify what is concerning to survivors. The extent of how and if this gets done is highly variable, and rarer still is ability for clinicians to use the information in real time to inform the visit."

SOURCE: American Society of Breast Surgeons annual meeting, held April 29 to May 2, 2021.