Skip to main content

Advertisement

SpringerLink
Log in

The Symptom Burden in Breast Cancer Survivors

  • Psycho-Oncology and Supportive Care (WWT Lam, Section Editor)
  • Published:
Current Breast Cancer Reports Aims and scope Submit manuscript

Abstract

Breast cancer survivors continue to experience an array of physical, psychological and cognitive symptoms following the completion of their treatment. However, there is a lack of understanding of symptom burden during an extended and long-term survivorship. The present review attempts to provide an overview of conceptual and contextual understanding of symptom burden that women with breast cancer may experience following treatment completion. We will focus on six commonly reported symptoms or symptom clusters in post-treatment breast cancer survivors, including menopausal symptoms, lymphoedema, fatigue, depression, sleep disturbance and cognitive dysfunction. To identify and manage the symptom burden effectively, further investigation is required into individual symptoms and their relationship to others.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. DeSantis CE, Lin CC, Mariotto AB, Siegel RL, Stein KD, Kramer JL, et al. Cancer treatment and survivorship statistics, 2014. CA Cancer J Clin. 2014;64(4):252–71.

    Article  PubMed  Google Scholar 

  2. Mullan F. Seasons of survival: reflections of a physician with cancer. New Engl J Med. 1985;313(4):270–3.

    Article  CAS  PubMed  Google Scholar 

  3. Mols F, Vingerhoets AJ, Coebergh JW, van de Poll-Franse LV. Quality of life among long-term breast cancer survivors: a systematic review. Eur J Cancer. 2005;41(17):2613–9.

    Article  PubMed  Google Scholar 

  4. So WK, Chow KM, Chan HY, Choi KC, Wan RW, Mak SS, et al. Quality of life and most prevalent unmet needs of Chinese breast cancer survivors at one year after cancer treatment. Eur J Oncol Nurs. 2014;18(3):323–8.

    Article  PubMed  Google Scholar 

  5. Pinto AC, de Azambuja E. Improving quality of life after breast cancer: dealing with symptoms. Maturitas. 2011;70(4):343–8.

    Article  PubMed  Google Scholar 

  6. Gapstur RL. Symptom burden: a concept analysis and implications for oncology nurses. Oncol Nurs Forum. 2007;34(3):673–80.

    Article  PubMed  Google Scholar 

  7. Kim HJ, McGuire DB, Tulman L, Barsevick AM. Symptom clusters: concept analysis and clinical implications for cancer nursing. Cancer Nurs. 2005;28(4):270–82.

    Article  PubMed  Google Scholar 

  8. Cleeland CS, Reyes-Gibby CC. When is it justified to treat symptoms? Measuring symptom burden. Oncology (Williston Park, NY). 2002;16(9 Suppl 10):64–70.

    Google Scholar 

  9. Bower JE. Behavioral symptoms in patients with breast cancer and survivors. J Clin Oncol. 2008;26(5):768–77.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Desbiens NA, Mueller-Rizner N, Connors Jr AF, Wenger NS, Lynn J. The symptom burden of seriously ill hospitalized patients. J Pain Symptom Manag. 1999;17:248–55.

    Article  CAS  Google Scholar 

  11. Cleeland CS. Symptom burden: multiple symptoms and their impact as patient-reported outcomes. J Natl Cancer Inst Monogr. 2007;(37):16–21. This study conceptualizes symptom burden among cancer population.

  12. Gill A, Chakraborty A, Selby D. What is symptom burden: a qualitative exploration of patient. J Palliat Care. 2012;28(2):83–9.

    PubMed  Google Scholar 

  13. Cheng KK, Darshini Devi RD, Wong WH, Koh C. Perceived symptoms and the supportive care needs of breast cancer survivors six months to five years post-treatment period. Eur J Oncol Nurs. 2014;18(1):3–9.

    Article  CAS  PubMed  Google Scholar 

  14. Roiland RA, Heidrich SM. Symptom clusters and quality of life in older breast cancer survivors. Oncol Nurs Forum. 2011;38(6):672–80.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Hickey M, Emer LI, Gregson J, Doherty D, Saunders CM. The multidisciplinary management of menopausal symptoms after breast cancer: a unique model of care. Menopause. 2010;17(4):727–33.

    PubMed  Google Scholar 

  16. Brisbois MD. An interpretive description of chemotherapy-induced premature menopause among Latinas with breast cancer. Oncol Nurs Forum. 2014;41(5):E282–9.

    Article  PubMed  Google Scholar 

  17. van Londen GJ, Donovan HS, Beckjord EB, Cardy AL, Bovbjerg DH, Davidson NE, et al. Perspectives of postmenopausal breast cancer survivors on adjuvant endocrine therapy-related symptoms. Oncol Nurs Forum. 2014;41(6):660–8.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Davis SR, Panjari M, Robinson PJ, Fradkin P, Bell RJ. Menopausal symptoms in breast cancer survivors nearly 6 years after diagnosis. Menopause. 2014;21(10):1075–81.

    Article  PubMed  Google Scholar 

  19. Gupta P, Sturdee DW, Palin SL, Majumder K, Fear R, Marshall T, et al. Menopausal symptoms in women treated for breast cancer: the prevalence and severity of symptoms and their perceived effects on quality of life. Climacteric. 2006;9(1):49–58.

    Article  CAS  PubMed  Google Scholar 

  20. Mortimer J, Behrendt CE. Severe menopausal symptoms are widespread among survivors of breast cancer treatment regardless of time since diagnosis. J Palliat Med. 2013;6(9):1130–4.

    Article  Google Scholar 

  21. Vincent AJ, Ranasinha S, Sayakhot P, Mansfield D, Teede HJ. Sleep difficulty mediates effects of vasomotor symptoms on mood in younger breast cancer survivors. Climacteric. 2014;17(5):598–604.

    Article  CAS  PubMed  Google Scholar 

  22. Savard MH, Savard J, Caplette-Gingras A, Ivers H, Bastien C. Relationship between objectively recorded hot flashes and sleep disturbances among breast cancer patients: investigating hot flash characteristics other than frequency. Menopause. 2013;20(10):997–1005.

    Article  PubMed  Google Scholar 

  23. Lavigne JE, Griggs JJ, Tu XM, Lerner DJ. Hot flashes, fatigue, treatment exposures and work productivity in breast cancer survivors. J Cancer Surviv. 2008;2(4):296–302.

    Article  PubMed  Google Scholar 

  24. Chim K, Xie SX, Stricker CT, Li QS, Gross R, Farrar JT, et al. Joint pain severity predicts premature discontinuation of aromatase inhibitors in breast cancer survivors. BMC Cancer. 2013;13(1):401.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Kidwell KM, Harte SE, Hayes DF, Storniolo AM, Carpenter J, Flockhart DA, et al. Patient‐reported symptoms and discontinuation of adjuvant aromatase inhibitor therapy. Cancer. 2014;120(16):2403–11.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Kyvernitakis I, Ziller V, Hars O, Bauer M, Kalder M, Hadji P. Prevalence of menopausal symptoms and their influence on adherence in women with breast cancer. Climacteric. 2014;17(3):252–9.

    Article  CAS  PubMed  Google Scholar 

  27. Mortimer P. Arm lymphoedema after breast cancer. Lancet Oncol. 2013;14(6):442–3.

    Article  PubMed  Google Scholar 

  28. Burckhardt M, Belzner M, Berg A, Fleischer S. Living with breast cancer-related lymphedema: a synthesis of qualitative research. Oncol Nurs Forum. 2014;41(4):E220–237.

    Article  PubMed  Google Scholar 

  29. DiSipio T, Rye S, Newman B, Hayes S. Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis. Lancet Oncol. 2013;14(6):500–15.

    Article  PubMed  Google Scholar 

  30. Norman SA, Localio AR, Potashnik SL, Simoes Torpey HA, Kallan MJ, Weber AL, et al. Lymphedema in breast cancer survivors: incidence, degree, time course, treatment, and symptoms. J Clin Oncol. 2009;27(3):390–7.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Fu MR, Ridner SH, Hu SH, Stewart BR, Cormier JN, Armer JM. Psychosocial impact of lymphedema: a systematic review of literature from 2004 to 2011. Psycho-Oncology. 2013;22(7):1466–84.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Taghian NR, Miller CL, Jammallo LS, O’Toole J, Skolny MN. Lymphedema following breast cancer treatment and impact on quality of life: a review. Crit Rev Oncol Hematol. 2014;92(3):227–34.

    Article  PubMed  Google Scholar 

  33. Cheng H, Sit JW, Cheng KK. Negative and positive life changes following treatment completion: Chinese breast cancer survivors’ perspectives. Support Care Cancer. 2015. doi:10.1007/s00520-015-2845-z.

    Google Scholar 

  34. Das N, Baumgartner RN, Riley EC, Pinkston CM, Yang D, Baumgartner KB. Treatment-related risk factors for arm lymphedema among long-term breast cancer survivors. J Cancer Surviv. 2015;9(3):422–30.

    Article  PubMed  Google Scholar 

  35. So WK, Marsh G, Ling WM, Leung FY, Lo JC, Yeung M, et al. Fatigue and quality of life of women undergoing chemotherapy or radiotherapy for breast cancer. Clin Oncol Cancer Res. 2009;6(3):179–85.

    Article  Google Scholar 

  36. Minton O, Stone P. How common is fatigue in disease-free breast cancer survivors? A systematic review of the literature. Breast Cancer Res Treat. 2008;112(1):5–13.

    Article  CAS  PubMed  Google Scholar 

  37. Reinertsen KV, Cvancarova M, Loge JH, Edvardsen H, Wist E, Fosså SD. Predictors and course of chronic fatigue in long-term breast cancer survivors. J Cancer Surviv. 2010;4(4):405–14.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Romito F, Cormio C, Giotta F, Colucci G, Mattioli V. Quality of life, fatigue and depression in Italian long-term breast cancer survivors. Support Care Cancer. 2012;20(11):2941–8.

    Article  PubMed  Google Scholar 

  39. Andrykowski MA, Donovan KA, Laronga C, Jacobsen PB. Prevalence, predictors, and characteristics of off‐treatment fatigue in breast cancer survivors. Cancer. 2010;116(24):5740–8.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Schmidt ME, Chang-Claude J, Vrieling A, Heinz J, Flesch-Janys D, Steindorf K. Fatigue and quality of life in breast cancer survivors: temporal courses and long-term pattern. J Cancer Surviv. 2012;6(1):11–9.

    Article  PubMed  Google Scholar 

  41. Goldstein D, Bennett BK, Webber K, Boyle F, de Souza PL, Wilcken NR, et al. Cancer-related fatigue in women with breast cancer: outcomes of a 5-year prospective cohort study. J Clin Oncol. 2012;30(15):1805–12.

    Article  PubMed  Google Scholar 

  42. Garabeli Cavalli Kluthcovsky AC, Urbanetz AA, de Carvalho DS, Pereira Maluf EM, Schlickmann Sylvestre GC, Bonatto Hatschbach SB. Fatigue after treatment in breast cancer survivors: prevalence, determinants and impact on health-related quality of life. Support Care Cancer. 2012;20(8):1901–9.

    Article  PubMed  Google Scholar 

  43. Bower JE, Bak K, Berger A, Breitbart W, Escalante CP, Ganz PA, et al. Screening, assessment, and management of fatigue in adult survivors of cancer: an American Society of Clinical oncology clinical practice guideline adaptation. J Clin Oncol. 2014;32(17):1840–50.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Kim SH, Son BH, Hwang SY, Han W, Yang JH, Lee S, et al. Fatigue and depression in disease-free breast cancer survivors: prevalence, correlates, and association with quality of life. J Pain Symptom Manag. 2008;35(6):644–55.

    Article  Google Scholar 

  45. Meeske K, Smith AW, Alfano CM, McGregor BA, McTiernan A, Baumgartner KB, et al. Fatigue in breast cancer survivors two to five years post diagnosis: a HEAL study report. Qual Life Res. 2007;16(6):947–60.

    Article  PubMed  Google Scholar 

  46. Alexander S, Minton O, Andrews P, Stone P. A comparison of the characteristics of disease-free breast cancer survivors with or without cancer-related fatigue syndrome. Eur J Cancer. 2009;45(3):384–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. So WK, Leung DY, Ho SS, Lai ET, Sit JW, Chan CW. Associations between social support, prevalent symptoms and health-related quality of life in Chinese women undergoing treatment for breast cancer: a cross-sectional study using structural equation modelling. Eur J Oncol Nurs. 2013;17(4):442–8.

    Article  PubMed  Google Scholar 

  48. So WK, Marsh G, Ling WM, Leung FY, Lo JC, Yeung M, et al. Anxiety, depression and quality of life among Chinese breast cancer patients during adjuvant therapy. Eur J Oncol Nurs. 2010;14(1):17–22.

    Article  PubMed  Google Scholar 

  49. Mausbach BT, Schwab RB, Irwin SA. Depression as a predictor of adherence to adjuvant endocrine therapy (AET) in women with breast cancer: a systematic review and meta-analysis. Breast Cancer Res Treat. 2015;152(2):239–46.

    Article  CAS  PubMed  Google Scholar 

  50. Vodermaier A, Linden W, Rnic K, Young SN, Ng A, Ditsch N, et al. Prospective associations of depression with survival: a population-based cohort study in patients with newly diagnosed breast cancer. Breast Cancer Res Treat. 2014;143(2):373–84.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Maass SW, Roorda C, Berendsen AJ, Verhaak PF, de Bock GH. The prevalence of long-term symptoms of depression and anxiety after breast cancer treatment: a systematic review. Maturitas. 2015;82:100–8.

    Article  CAS  PubMed  Google Scholar 

  52. Accortt EE, Bower JE, Stanton AL, Ganz PA. Depression and vasomotor symptoms in young breast cancer survivors: the mediating role of sleep disturbance. Arch Womens Ment Health. 2015;18(3):565–8.

    Article  PubMed  Google Scholar 

  53. Christie KM, Meyerowitz BE, Maly RC. Depression and sexual adjustment following breast cancer in low‐income Hispanic and non‐Hispanic White women. Psycho-Oncology. 2010;19(10):1069–77.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Brunault P, Suzanne I, Trzepidur‐Edom M, Garaud P, Calais G, Toledano A, et al. Depression is associated with some patient‐perceived cosmetic changes, but not with radiotherapy‐induced late toxicity, in long‐term breast cancer survivors. Psycho-Oncology. 2013;22(3):590–7.

    Article  PubMed  Google Scholar 

  55. Den Oudsten BL, Van Heck GL, Van der Steeg AF, Roukema JA, De Vries J. Predictors of depressive symptoms 12 months after surgical treatment of early‐stage breast cancer. Psycho-Oncology. 2009;18(11):1230–7.

    Article  Google Scholar 

  56. Schleife H, Sachtleben C, Barboza CF, Singer S, Hinz A. Anxiety, depression, and quality of life in German ambulatory breast cancer patients. Breast Cancer. 2014;21(2):208–13.

    Article  PubMed  Google Scholar 

  57. So WK, Marsh G, Ling WM, Leung FY, Lo JC, Yeung M, et al. The symptom cluster of fatigue, pain, anxiety, and depression and the effect on the quality of life of women receiving treatment for breast cancer: a multicenter study. Oncol Nurs Forum. 2009;36(4):E205–14.

    Article  PubMed  Google Scholar 

  58. Ho SY, Rohan KJ, Parent J, Tager FA, McKinley PS. A longitudinal study of depression, fatigue, and sleep disturbances as a symptom cluster in women with breast cancer. J Pain Symptom Manag. 2015;49(4):707–15.

    Article  Google Scholar 

  59. Lockefeer JP, De Vries J. What is the relationship between trait anxiety and depressive symptoms, fatigue, and low sleep quality following breast cancer surgery? Psycho-Oncology. 2013;22(5):1127–33.

    Article  CAS  PubMed  Google Scholar 

  60. Karakoyun-Celik O, Gorken I, Sahin S, Orcin E, Alanyali H, Kinay M. Depression and anxiety levels in woman under follow-up for breast cancer: relationship to coping with cancer and quality of life. Med Oncol. 2010;27(1):108–13.

    Article  PubMed  Google Scholar 

  61. Bower JE, Ganz PA, Irwin MR, Kwan L, Breen EC, Cole SW. Inflammation and behavioral symptoms after breast cancer treatment: do fatigue, depression, and sleep disturbance share a common underlying mechanism? J Clin Oncol. 2011;29(26):3517–22.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Taylor TR, Huntley ED, Makambi K, Sween J, Adams‐Campbell LL, Frederick W, et al. Understanding sleep disturbances in African‐American breast cancer survivors: a pilot study. Psycho-Oncology. 2012;21(8):896–902.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Alfano CM, Lichstein KL, Vander Wal GS, Smith AW, Reeve BB, McTiernan A, et al. Sleep duration change across breast cancer survivorship: associations with symptoms and health-related quality of life. Breast Cancer Res Treat. 2011;130(1):243–54.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Dahl AA, Nesvold IL, Reinertsen KV, Fossa SD. Arm/shoulder problems and insomnia symptoms in breast cancer survivors: cross-sectional, controlled and longitudinal observations. Sleep Med. 2011;12(6):584–90.

    Article  PubMed  Google Scholar 

  65. Koppelmans V, Breteler MM, Boogerd W, Seynaeve C, Gundy C, Schagen SB. Neuropsychological performance in survivors of breast cancer more than 20 years after adjuvant chemotherapy. J Clin Oncol. 2012;30(10):1080–6.

    Article  PubMed  Google Scholar 

  66. Jim HS, Phillips KM, Chait S, Faul LA, Popa MA, Lee YH, et al. Meta-analysis of cognitive functioning in breast cancer survivors previously treated with standard-dose chemotherapy. J Clin Oncol. 2012;30(29):3578–87.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  67. Pullens MJ, De Vries J, Roukema JA. Subjective cognitive dysfunction in breast cancer patients: a systematic review. Psycho-Oncology. 2010;19(11):1127–38.

    Article  PubMed  Google Scholar 

  68. Biglia N, Bounous VE, Malabaila A, Palmisano D, Torta DM, D’Alonzo M, et al. Objective and self‐reported cognitive dysfunction in breast cancer women treated with chemotherapy: a prospective study. Eur J Cancer Care. 2012;21(4):485–92.

    Article  CAS  Google Scholar 

  69. Aktas A, Walsh D, Kirkova J. The psychometric properties of cancer multisymptom assessment instruments: a clinical review. Support Care Cancer. 2015;23(7):2189–202. This review summarizes the existing instruments for measuring symptom burden in cancer population.

    Article  PubMed  Google Scholar 

  70. Cheng H, Sit JW, Chan CW, So WK, Choi KC, Cheng KK. Social support and quality of life among Chinese breast cancer survivors: findings from a mixed methods study. Eur J Oncol Nurs. 2013;17(6):788–96.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China

    Huilin Cheng

  2. The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China

    Janet W. H. Sit & Winnie K. W. So

Authors
  1. Huilin Cheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Janet W. H. Sit
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Winnie K. W. So
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Winnie K. W. So.

Ethics declarations

Conflict of Interest

Huilin Cheng, Janet W.H. Sit and Winnie K.W. So declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Psycho-Oncology and Supportive Care

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cheng, H., Sit, J.W.H. & So, W.K.W. The Symptom Burden in Breast Cancer Survivors. Curr Breast Cancer Rep 8, 40–46 (2016). https://doi.org/10.1007/s12609-016-0201-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12609-016-0201-z

Keywords

Search

Navigation