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Breast cancer survivorship: state of the science

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Abstract

Purpose

Only recently has breast cancer survivorship earned formal recognition as a research discipline. Complicating survivorship research is the frequent overlap between aging and treatment sequelae. The ACS/ASCO 2016 Breast Cancer Survivorship Care Guideline (Guideline) reflects comprehensive literature review through April 2015, while the jointly sponsored, inaugural Cancer Survivorship Symposium in 2016 (Symposium) reflects ongoing research activity in the area. Together, these platforms provide an opportunity to examine the use of randomized trials and controlled studies in survivorship care research.

Methods

All 236 citations from the Guideline and all 250 abstracts from the Symposium were reviewed independently by two authors and assigned to prospectively determined categories.

Results

Guideline citations were most frequently reviews (n = 88, 37.3%) and non-randomized, non-controlled studies (n = 51, 21.6%). Thirty-seven (15.7%) randomized trials were cited. Only 9% of Guideline recommendations were based on randomized clinical trial evidence, while 64% were based on evidence level "0" (expert opinion, clinical practice, etc.). Symposium abstracts consisted largely of non-randomized, non-controlled studies (n = 113, 45.2%), with ten completed randomized trials (4%). Few Guideline citations or Symposium abstracts incorporated matched, cancer-free controls.

Conclusions

Based on the literature underlying the ASCO Guideline as well as a survey of the Cancer Survivorship Symposium abstracts, a significant proportion of the survivorship literature at least through 2015 consisted of non-randomized, non-controlled studies. To optimally address survivorship issues, cancer therapy sequelae need to be distinguished from normal aging in studies incorporating cancer-free controls, and randomized clinical trials are needed to inform intervention strategies.

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Role of the Sponsor

The WHI Project Office at the US National Heart, Lung, and Blood Institute (NHLBI) reviewed and approved the final manuscript but had no other role in the preparation of this report.

Funding

The WHI program is reported by the National Heart, Lung and Blood Institute, National Institutes of Health, Department of Health and Human Services through contracts N01WH22110, 24152, 32100-2, 32105-6, 32108-9, 32111-13, 32115, 32118-32119, 32122, 42107-26, 42129-32, and 44221.

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Authors and Affiliations

  1. Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1124 W. Carson St., N16, Torrance, CA, 90502, USA

    Kathy Pan

  2. Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, CA, USA

    Arti Hurria & Rowan T. Chlebowski

Authors
  1. Kathy Pan
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  2. Arti Hurria
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  3. Rowan T. Chlebowski
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Contributions

KP and RTC wrote the analysis proposal and initial draft of the report. KP and RTC had full access to the data in the study and take full responsibility for the integrity of the data and the accuracy of the data analysis. AH, KP, and RTC provided critical revision of the manuscript for intellectual content.

Corresponding author

Correspondence to Kathy Pan.

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Conflict of interest disclosures

All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr. Hurria reported being a consultant for Pierian Biosciences and MJH Healthcare Holdings, LLC and receiving research funding from Celgene and Novartis. Dr. Chlebowski reported being a consultant for AstraZeneca, Novartis, Genentech, and Pfizer; and serving on speaker’s bureau for Novartis, Astra-Zeneca, and Genentech.

Additional information

The current findings were included in a poster presentation at the 2017 ASCO Cancer Survivorship Symposium on January 27, 2017.

Women’s Health Initiative Investigators

Women’s Health Initiative Investigators

Program Office (National Heart, Lung, and Blood Institute, Bethesda, MD) Jacques Roscoe, Shari Ludlum, Dale Burden, Joan McGowan, Leslie Ford, and Nancy Geller

Clinical Coordinating Center (Fred Hutchinson Cancer Research Center, Seattle, WA) Garnet Anderson, Ross Prentice, Andrea LaCroix, and Charles Kooperberg

Investigators and Academic Centers (Brigham and Women’s Hospital, Harvard Medical School, Boston, MA) JoAnn E Manson; (MedStar Health Research Institute/Howard University, Washington, DC) Barbara V Howard; (Stanford Prevention Research Center, Stanford, CA) Marcia L. Stefanick; (The Ohio State University, Columbus, OH) Rebecca Jackson; (University of Arizona, Tucson/Phoenix, AZ) Cynthia A. Thompson; (University at Buffalo, Buffalo, NY) Jean Wactawski-Wende; (University of Florida, Gainesville/Jacksonville, FL) Marian Limacher; (University of Iowa, Iowa City/Davenport, IA) Robert Wallace; (University of Pittsburgh, Pittsburgh, PA) Lewis Kuller; City of Hope National Medical Center, Duarte, CA) Rowan T. Chlebowski; (Wake Forest University School of Medicine, Winston-Salem, NC) Sally Shumaker

Additional information A full list of all the investigators who have contributed to Women’s Health Initiative science appears at https://www.whi.org/researchers/Documents%20%20Write%20a%20Paper/WHI%20Investigator%20Long%20List.pdf.

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Pan, K., Hurria, A. & Chlebowski, R.T. Breast cancer survivorship: state of the science. Breast Cancer Res Treat 168, 593–600 (2018). https://doi.org/10.1007/s10549-017-4650-5

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