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Varying severities of symptoms underline the relevance of personalized follow-up care in breast cancer survivors: latent class cluster analyses in a cross-sectional cohort

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Abstract

Purpose

Insights into the severity of co-existing symptoms can help in identifying breast cancer survivors in need of symptom management. We aimed to identify subgroups of breast cancer survivors based on patterns of symptom severity, and characteristics associated with these subgroups.

Methods

We selected surgically treated stage I–III breast cancer survivors 1–5 years post-diagnosis from the Netherlands Cancer Registry (N = 876). We assessed experienced severity of fatigue, nausea, pain, dyspnea, insomnia, appetite, constipation, diarrhea, and emotional and cognitive symptoms through the EORTC-QLQ-C30 Quality of Life Questionnaire on a scale of 0–100. We determined subgroups of survivors using latent class cluster analyses (LCA) based on severity of co-existing symptoms and compared their mean severity to the age-matched female reference population to interpret clinical relevance. We assessed subgroup characteristics by multinomial logistic regression analyses.

Results

From 404 respondents (46%), three subgroups of survivors with distinct symptom severity were identified: low severity (n = 116, 28.7%), intermediate severity (n = 224, 55.4%), and high severity (n = 59, 14.6%). The low subgroup reported lower symptom severity than the general population; the intermediate subgroup reported a similar symptom severity, although scores for fatigue, insomnia, and cognitive symptoms were worse (small-medium clinical relevance). The high subgroup had worse symptom severity (medium-large clinical relevance). Compared to the intermediate subgroup, one (RRR: 2.75; CI: 1.22–6.19; p = 0.015) or more (RRR: 9.19; CI: 3.70–22.8; p =  < 0.001) comorbidities were significantly associated with the high subgroup. We found no associated treatment characteristics.

Conclusion

We identified distinct subgroups of breast cancer survivors based on symptom severity, underlining the relevance of further exploring personalized follow-up strategies.

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Data availability

The data that support the findings of this study are available from the Netherlands Cancer Registry but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of the Netherlands Cancer Registry.

Code availability

Codes written in Latent GOLD version 5.2.0; Stata/SE 14.2. Codes are available at the corresponding author upon reasonable request.

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Acknowledgements

The authors thank all women who participated in completing the survey.

Author information

Authors and Affiliations

  1. Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, PO Box 90203, 1006 BE, Amsterdam, The Netherlands

    Kelly M. de Ligt, Iris Walraven & Lonneke V. van de Poll-Franse

  2. Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands

    Belle H. de Rooij, Janneke Verloop, Sabine Siesling & Lonneke V. van de Poll-Franse

  3. CoRPS - Center of Research On Psychology in Somatic Diseases/Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands

    Belle H. de Rooij & Lonneke V. van de Poll-Franse

  4. Department for Health Evidence, RadboudUMC, Nijmegen, The Netherlands

    Iris Walraven

  5. Nivel, Netherlands Institute of Health Services Research, Utrecht, Netherlands

    Marianne J. Heins & Joke C. Korevaar

  6. Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands

    Sabine Siesling

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  1. Kelly M. de Ligt
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  8. Lonneke V. van de Poll-Franse
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Contributions

Conceptualization: K.M. de Ligt, B.H. de Rooij, I. Walraven, M.J. Heins, J. Verloop, S. Siesling, J.C. Korevaar, L.V. van de Poll-Franse.

Methodology: K.M. de Ligt, B.H. de Rooij, I. Walraven, M.J. Heins, J. Verloop, S. Siesling, J.C. Korevaar, L.V. van de Poll-Franse.

Formal analyses and investigation: K.M. de Ligt, B.H. de Rooij.

Writing – original draft preparation: K.M. de Ligt.

Writing – review and editing: B.H. de Rooij, I. Walraven, M.J. Heins, J. Verloop, S. Siesling, J.C. Korevaar, L.V. van de Poll-Franse.

All authors have read and approved the final version of the manuscript to be published. The authors ensure that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Kelly M. de Ligt.

Ethics declarations

Ethics approval

The use of data from the Netherlands Cancer Registry (NCR) was approved by the NCR Privacy Review Board. Formal ethical approval was not required, as the Dutch Medical Research (Human Subjects) Act did not apply for this study.

Consent to participate

Informed consent was obtained from all individual participants included in the study. Participants gave consent for processing their coded responses and merging these with their clinical data available in the NCR.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

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Plain English language summary.

Many breast cancer survivors suffer from symptoms that may have been caused by the cancer and treatment. To date, these symptoms have been researched as separate symptoms. However, cancer survivors often suffer from multiple symptoms at the same time. We aimed to identify groups of breast cancer survivors based on their overall symptom burden. We found three subgroups of survivors, with either lower, comparable, or higher symptom burden than the general population. We also investigated which characteristics were associated with these subgroups. We found that patients with other diseases besides breast cancer had an increased risk for high symptom burden.

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de Ligt, K.M., de Rooij, B.H., Walraven, I. et al. Varying severities of symptoms underline the relevance of personalized follow-up care in breast cancer survivors: latent class cluster analyses in a cross-sectional cohort. Support Care Cancer 30, 7873–7883 (2022). https://doi.org/10.1007/s00520-022-07229-6

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  • DOI: https://doi.org/10.1007/s00520-022-07229-6

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