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Associations between adjuvant endocrine therapy and onset of physical and emotional concerns among breast cancer survivors

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Abstract

Background

Breast cancer survivors often receive long-term adjuvant endocrine therapy (AET) to reduce recurrence risk. Adherence to AET is suboptimal, which may be due to the experience of symptoms and/or concerns. Few studies have comprehensively assessed self-reported concerns between those who currently, previously or have never received AET. The study objective is to describe self-reported physical and emotional concerns of breast cancer survivors who are current, prior, or never-recipients of AET.

Methods

Secondary analysis was performed on a subset of survey data collected in the 2010 LIVESTRONG Survey. Breast cancer survivors (n = 1,013, mean 5.4 years post-diagnosis) reported on 14 physical and eight emotional concerns that began after diagnosis and were experienced within 6 months of participation in the survey. Bivariate analyses examined the prevalence of each concern by AET status. The relationships between AET and burden of physical or emotional concerns were modeled with logistic regression.

Results

More than 50 % of the participants reported currently experiencing cognitive issues, fatigue, fear of recurrence, emotional distress, and identity/grief issues. Thyroid dysfunction and stigma concerns were more common among participants with prior AET (p < 0.01), while fear of recurrence, emotional distress, and concern about appearance were more common among those currently receiving AET (p < 0.01). Fatigue, sexual dysfunction, and pain were more common among prior and current AET recipients (p < 0.01). In adjusted models, receipt of AET was associated with a higher number of physical, but not emotional concerns. A higher number of concerns was associated with younger age, having children, receipt of chemotherapy, longer duration of cancer treatment, and shorter time since diagnosis (p < 0.01).

Conclusions

Breast cancer survivors who received AET were at risk of developing a variety of physical and emotional concerns, many of which persisted after treatment. These findings suggest the importance of developing individualized, supportive resources for breast cancer survivors.

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References

  1. Siegel R, Naishadham D, Jemal A (2013) Cancer statistics, 2013. CA Cancer J Clin 63(1):11–30. doi:10.3322/caac.21166

    Article  PubMed  Google Scholar 

  2. Jemal A, Ward E, Thun MJ (2007) Recent trends in breast cancer incidence rates by age and tumor characteristics among U.S. women. Breast Cancer Res 9(3):R28

    Article  PubMed Central  PubMed  Google Scholar 

  3. Burstein HJ, Prestrud AA, Seidenfeld J, Anderson H, Buchholz TA, Davidson NE, Gelmon KE, Giordano SH, Hudis CA, Malin J, Mamounas EP, Rowden D, Solky AJ, Sowers MR, Stearns V, Winer EP, Somerfield MR, Griggs JJ (2010) American Society of Clinical Oncology clinical practice guideline: update on adjuvant endocrine therapy for women with hormone receptor-positive breast cancer. J Clin Oncol 28(23):3784–3796. doi:10.1200/JCO.2009.26.3756

    Article  PubMed  Google Scholar 

  4. Aydiner A (2013) Meta-analysis of breast cancer outcome and toxicity in adjuvant trials of aromatase inhibitors in postmenopausal women. Breast 22(2):121–129. doi:10.1016/j.breast.2013.01.014

    Article  PubMed  Google Scholar 

  5. Aiello Bowles EJ, Boudreau DM, Chubak J, Yu O, Fujii M, Chestnut J, Buist DS (2012) Patient-reported discontinuation of endocrine therapy and related adverse effects among women with early-stage breast cancer. J Oncol Pract 8(6):e149–e157. doi:10.1200/JOP.2012.000543

    Article  PubMed Central  PubMed  Google Scholar 

  6. Henry NL, Azzouz F, Desta Z, Li L, Nguyen AT, Lemler S, Hayden J, Tarpinian K, Yakim E, Flockhart DA, Stearns V, Hayes DF, Storniolo AM (2012) Predictors of aromatase inhibitor discontinuation as a result of treatment-emergent symptoms in early-stage breast cancer. J Clin Oncol 30(9):936–942. doi:10.1200/JCO.2011.38.0261

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Ochayon L, Zelker R, Kaduri L, Kadmon I (2010) Relationship between severity of symptoms and quality of life in patients with breast cancer receiving adjuvant hormonal therapy. Oncol Nurs Forum 37(5):E349–E358. doi:10.1188/10.ONF.E349-E358

    Article  PubMed  Google Scholar 

  8. Hanchate AD, Clough-Gorr KM, Ash AS, Thwin SS, Silliman RA (2010) Longitudinal patterns in survival, comorbidity, healthcare utilization and quality of care among older women following breast cancer diagnosis. J Gen Intern Med 25(10):1045–1050. doi:10.1007/s11606-010-1407-9

    Article  PubMed Central  PubMed  Google Scholar 

  9. Bloom JR, Kang SH, Petersen DM, Stewart SL (2007) Quality of life in long-term cancer survivors. In: Feuerstein M (ed) Handbook of cancer survivorship. Springer Science + Business Media, New York, pp 43–65

    Chapter  Google Scholar 

  10. Binkley JM, Harris SR, Levangie PK, Pearl M, Guglielmino J, Kraus V, Rowden D (2012) Patient perspectives on breast cancer treatment side effects and the prospective surveillance model for physical rehabilitation for women with breast cancer. Cancer 118(8 Suppl):2207–2216. doi:10.1002/cncr.27469

    Article  PubMed  Google Scholar 

  11. Lin JH, Zhang SM, Manson JE (2011) Predicting adherence to tamoxifen for breast cancer adjuvant therapy and prevention. Cancer Prev Res (Phila) 4(9):1360–1365. doi:10.1158/1940-6207.CAPR-11-0380

    Article  CAS  Google Scholar 

  12. Hershman DL, Shao T, Kushi LH, Buono D, Tsai WY, Fehrenbacher L, Kwan M, Gomez SL, Neugut AI (2010) Early discontinuation and non-adherence to adjuvant hormonal therapy are associated with increased mortality in women with breast cancer. Breast Cancer Res Treat. doi:10.1007/s10549-010-1132-4

    Google Scholar 

  13. Fallowfield LJ, Kilburn LS, Langridge C, Snowdon CF, Bliss JM, Coombes RC, Committee IESTS (2012) Long-term assessment of quality of life in the Intergroup Exemestane Study: 5 years post-randomisation. Br J Cancer 106(6):1062–1067. doi:10.1038/bjc.2012.43

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. Koch L, Jansen L, Herrmann A, Stegmaier C, Holleczek B, Singer S, Brenner H, Arndt V (2013) Quality of life in long-term breast cancer survivors — a 10-year longitudinal population-based study. Acta Oncol 52(6):1119–1128. doi:10.3109/0284186X.2013.774461

    Article  PubMed  Google Scholar 

  15. Murgic J, Soldic Z, Vrljic D, Samija I, Kirac I, Bolanca A, Kusic Z (2012) Quality of life of Croatian breast cancer patients receiving adjuvant treatment—comparison to long-term breast cancer survivors. Coll Anthropol 36(4):1335–1341

    Google Scholar 

  16. Rechis R, Reynolds KA, Beckjord EB, Nutt S, Burns RM, Schaefer JS (2011) "I Learned to Live With It" is not good enough: challenges reported by post-treatment cancer survivors in the LIVESTRONG Surveys. LIVESTRONG, Austin

    Google Scholar 

  17. Aziz NM (2007) Late effects of cancer treatments. In Ganz PA (ed) Cancer survivorship: today and tomorrow. Springer Science, New York, pp 54–76

  18. Casillas J, Ganz P (2009) Physical late effects of cancer: Implications for care. In: Miller SM, Bowen DJ, Croyle RT, Rowland JH (eds) Handbook of cancer control and behavioral science: a resource for researchers, practitioners, and policymakers. American Psychological Association, Washington, DC, pp 431–448

    Google Scholar 

  19. Demark-Wahnefried W, Aziz NM (2009) Health promotion and disease prevention in adult cancer survivors. In: Miller SM, Bowen DJ, Croyle RT, Rowland JH (eds) Handbook of cancer control and behavioral science: a resource for researchers, practitioners, and policymakers. American Psychological Association, Washington, DC, pp 487–494

    Google Scholar 

  20. Ganz PA (2009) Survivorship: adult cancer survivors. Prim Care 36(4):721–741. doi:10.1016/j.pop.2009.08.001

    Article  PubMed  Google Scholar 

  21. Stricker CT, Jacobs LA (2008) Physical late effects in adult cancer survivors. Oncology (Williston Park) 22(8 Suppl Nurse Ed):33–41

    Google Scholar 

  22. Avis NE, Smith KW, McGraw S, Smith RG, Petronis VM, Carver CS (2005) Assessing quality of life in adult cancer survivors (QLACS). Qual Life Res 14(4):1007–1023

    Article  PubMed  Google Scholar 

  23. Alfano CM, Rowland JH (2006) Recovery issues in cancer survivorship: a new challenge for supportive care. Cancer J 12(5):432–443

    Article  PubMed  Google Scholar 

  24. Turken O, NarIn Y, DemIrbas S, Onde ME, Sayan O, KandemIr EG, Yaylac IM, Ozturk A (2003) Breast cancer in association with thyroid disorders. Breast Cancer Res 5(5):R110–R113. doi:10.1186/bcr609

    Article  PubMed Central  PubMed  Google Scholar 

  25. Giani C, Fierabracci P, Bonacci R, Gigliotti A, Campani D, De Negri F, Cecchetti D, Martino E, Pinchera A (1996) Relationship between breast cancer and thyroid disease: relevance of autoimmune thyroid disorders in breast malignancy. J Clin Endocrinol Metab 81(3):990–994

    CAS  PubMed  Google Scholar 

  26. Smyth PP (2003) The thyroid, iodine and breast cancer. Breast Cancer Res 5(5):235–238. doi:10.1186/bcr638

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  27. Fan HG, Houede-Tchen N, Yi QL, Chemerynsky I, Downie FP, Sabate K, Tannock IF (2005) Fatigue, menopausal symptoms, and cognitive function in women after adjuvant chemotherapy for breast cancer: 1- and 2-year follow-up of a prospective controlled study. J Clin Oncol 23(31):8025–8032. doi:10.1200/JCO.2005.01.6550

    Article  PubMed  Google Scholar 

  28. Cluze C, Rey D, Huiart L, BenDiane MK, Bouhnik AD, Berenger C, Carrieri MP, Giorgi R (2012) Adjuvant endocrine therapy with tamoxifen in young women with breast cancer: determinants of interruptions vary over time. Ann Oncol 23(4):882–890. doi:10.1093/annonc/mdr330

    Article  CAS  PubMed  Google Scholar 

  29. Schlegel RJ, Manning MA, Molix LA, Talley AE, Bettencourt BA (2012) Predictors of depressive symptoms among breast cancer patients during the first year post diagnosis. Psychol Health 27(3):277–293. doi:10.1080/08870446.2011.559232

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We are grateful to Ms. A. Cardy for her critical reading and editing of this manuscript. Research reported in this publication was supported in part by the National Institutes of Health (KL2TR000146; P30 AG024827; P30 CA047904), the Hartford Foundation, Magee-Women’s Research Institute & Foundation, and the Pittsburgh Affiliate of Susan G. Komen for the Cure.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Medicine (Hematology–Oncology, Geriatric Medicine), University of Pittsburgh, Pittsburgh, PA, USA

    G. J. van Londen

  2. Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA

    G. J. van Londen & D. H. Bovbjerg

  3. Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA

    E. B. Beckjord, M. A. Dew, D. H. Bovbjerg & R. C. Thurston

  4. Biobehavioral Medicine in Oncology Program, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA

    E. B. Beckjord & D. H. Bovbjerg

  5. Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA

    M. A. Dew & D. H. Bovbjerg

  6. Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA

    M. A. Dew & R. C. Thurston

  7. Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA

    M. A. Dew

  8. University of Pittsburgh Cancer Institute Biostatistics Facility, Pittsburgh, PA, USA

    K. L. Cooper

  9. University of Pittsburgh Cancer Institute and UPMC Cancer Center, Pittsburgh, PA, USA

    N. E. Davidson

  10. Department of Behavioral and Community Health Science, University of Pittsburgh, Pittsburgh, PA, USA

    D. H. Bovbjerg

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

    H. S. Donovan

  12. Chatham University, Pittsburgh, PA, USA

    J. Q. Morse

  13. LIVESTRONG Foundation, Austin, TX, USA

    S. Nutt & R. Rechis

  14. S. 140 Cooper Pavilion, 5115 Centre Avenue, Pittsburgh, PA, 15232, USA

    G. J. van Londen

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  1. G. J. van Londen
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  2. E. B. Beckjord
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  3. M. A. Dew
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Correspondence to G. J. van Londen.

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van Londen, G.J., Beckjord, E.B., Dew, M.A. et al. Associations between adjuvant endocrine therapy and onset of physical and emotional concerns among breast cancer survivors. Support Care Cancer 22, 937–945 (2014). https://doi.org/10.1007/s00520-013-2041-y

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