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Trajectories of neuropsychological symptom burden in postmenopausal women prescribed anastrozole for early-stage breast cancer

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Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

Aromatase inhibitors (AIs) prolong survival for postmenopausal women with hormone receptor-positive breast cancer (HR + BC) but also burden patients with symptoms, a major reason for suboptimal AI adherence. This study characterizes inter-relationships among symptom measures; describes neuropsychological symptom burden trajectories; and identifies trajectory group membership predictors for postmenopausal women prescribed anastrozole for HR + BC.

Methods

This study utilized prospectively collected data from a cohort study. Relationships among various self-reported symptom measures were examined followed by a factor analysis to reduce data redundancy before trajectory analysis. Four neuropsychological scales/subscales were rescaled (range 0–100) and averaged into a neuropsychological symptom burden (NSB) score, where higher scores indicated greater symptom burden. Group-based trajectory modeling characterized NSB trajectories. Trajectory group membership predictors were identified using multinomial logistic regression.

Results

Women (N = 360) averaged 61 years old, were mostly White, and diagnosed with stage I HR + BC. Several measures were correlated temporally but four neuropsychological measures had strong correlations and dimensional loadings. These four measures, combined for the composite NSB, averaged (mean ± standard deviation) 17.4 ± 12.9, 18.0 ± 12.7, 19.5 ± 12.8, and 19.8 ± 13.0 at pre-anastrozole, 6, 12, and 18 months post-initiation, respectively. However, the analysis revealed five NSB trajectories—low-stable, low-increasing, moderate-stable, high-stable, and high-increasing. Younger age and baseline medication categories (pre-anastrozole), including anti-depressants, analgesics, anti-anxiety, and no calcium/vitamin D, predicted the higher NSB trajectories.

Conclusion

This study found relationships among neuropsychological symptom measures and distinct trajectories of self-reported NSB with pre-anastrozole predictors. Identifying symptom trajectories and their predictors at pre-anastrozole may inform supportive care strategies via symptom management interventions to optimize adherence for women with HR + BC.

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Data availability

Please contact corresponding author for data information.

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Acknowledgements

The authors would like to thank the women who participated in this research.

Funding

Parent study funding was from the National Cancer Institute R01CA107408 (PI: Bender) and Oncology Nursing Foundation (PI: Bender). This work was supported by the National Cancer Institute F99/K00 F99CA253771 (PI: McCall); the Rockefeller University Heilbrunn Family Center for Research Nursing through the generosity of the Heilbrunn Family; the American Cancer Society Doctoral Degree Scholarship in Cancer Nursing (DSCN-19- 049); the Oncology Nursing Foundation Research Doctoral Scholarship; and the University of Pittsburgh School of Nursing Undergraduate Research Mentorship Program (URMP).

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Authors and Affiliations

  1. University of Pittsburgh School of Nursing, Pittsburgh, PA, USA

    Maura K. McCall, Susan M. Sereika, Stephanie Snader, Alexa Lavanchy, Margaret Q. Rosenzweig, Yvette P. Conley & Catherine M. Bender

  2. University of Pittsburgh Public Health, Pittsburgh, PA, USA

    Susan M. Sereika & Yvette P. Conley

  3. UPMC Hillman Cancer Center, Pittsburgh, PA, USA

    Margaret Q. Rosenzweig, Jan H. Beumer & Catherine M. Bender

  4. University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA

    Jan H. Beumer

  5. Case Western Reserve University, Cleveland, OH, USA

    Maura K. McCall

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  1. Maura K. McCall
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Contributions

All authors contributed to the study conception and design. Data preparation was performed by M. McCall, S. Snader, A. Lavanchy, and S. Sereika. Analyses were performed by M. McCall and S. Sereika. The first draft of the manuscript was written by M. McCall with assistance from S. Snader and A. Lavanchy. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Maura K. McCall.

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Ethics approval

All procedures performed in studies involving participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The University of Pittsburgh Institutional Review Board approval for the parent study as well as this study. The protocol number for this study is STUDY19050318.

Consent to participate

All participants provided their informed consent obtained by study personnel from the parent study prior to any data collection.

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Conflict of interest

The authors declare no competing interests.

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Material in this article is reprinted from Maura K. McCall's dissertation with permission; dissertation available at McCall, Maura Kindelan (2022). Genotypic and Phenotypic Predictors of Cancer Therapy Adherence and Symptom Trajectories in Women with Breast Cancer. Doctoral Dissertation, University of Pittsburgh. (Unpublished) http://d-scholarship.pitt.edu/43604/.

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McCall, M.K., Sereika, S.M., Snader, S. et al. Trajectories of neuropsychological symptom burden in postmenopausal women prescribed anastrozole for early-stage breast cancer. Support Care Cancer 30, 9329–9340 (2022). https://doi.org/10.1007/s00520-022-07326-6

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