Abstract P4-10-10: The City of Hope breast cancer survivorship study: A longitudinal look at symptoms
Authors: Clague DeHart J , Cheung-Wong L , Smith R , Flores S , Mortimer J 
Published: May 2016

BACKGROUND: Breast cancer survivors report many symptoms post treatment. However, longitudinal data, including pre-treatment measures, are scarce making it difficult to accurately attribute symptoms, as patients experience many changes; hormonal fluctuation, chemotherapy, additive endocrine therapy. Therefore, we undertook this longitudinal study to distinguish the impact of these different treatments along the survivorship time course, starting with time at diagnosis.

METHODS: Female, breast cancer survivors completed symptom questionnaires (Qx) pre-treatment (pre-tx), at 6-months follow-up (during-tx) and 12-months (post-tx) follow-up. Women rated symptoms in the past week as not at all, a little bit, somewhat, quite a bit, and very much. Symptoms included, hot flashes, vaginal discharge, vaginal itching, vaginal dryness, pain during intercourse, loss of interest in intercourse, weight gain, dizziness, vomiting diarrhea, headaches, abdominal bloating, breast sensitivity, mood swings, irritability, and joint pain. Additional measures included view of overall health, overall pain in the past month, and average fatigue in the past week. Chi-square tests were conducted across time points and stratified by menopausal status and type of treatment. Symptom changes from baseline, clustered by subject, were entered into a generalized estimating equation (GEE) models.

RESULTS: Of the 237 breast cancer survivors (median pre-tx age: 53 years, range: 24-70), who completed the pre-tx Qx, 112 completed the 6-month Qx and 95 completed the 12-month Qx. Women reported an increase in hot flashes from pre-tx to 6-months (p&lt;0.001) and pre-tx to 12-months (p=0.04), with a slight decrease from 6 to 12 months (p=0.19). An increase in vomiting was observed from pre-tx to 6-months (p=0.04). Women reported an increase in vaginal discharge from pre-tx to 12-months (p=0.04), and a decrease in average fatigue in the past week from pre-tx to 12-months (p=0.04). Both overall pain in the past month and joint pain in the past week increased from pre-tx to 6-months and then decreased below pre-tx levels at 12-months (p=0.03 and p=0.12, respectively). Changes in hot flashes, vaginal dryness, pain during intercourse and weight gain were only observed among premenopausal women, while changes in vaginal discharge were only observed among postmenopausal women. GEE modeling showed associations between the use of endocrine therapy and increased hot flashes (Odds Ratio [OR]: 2.60, 95% Confidence Interval [CI]: 1.97-3.42), vaginal discharge (1.38; 1.15-1.66), pain during intercourse (1.34; 1.05-1.72), weight gain (1.61; 1.22-2.12) and joint pain (1.90; 1.48-2.45). By 12-months, severity of all symptoms decreased, except for vaginal discharge. Associations were observed between the use of chemotherapy and decreased weight gain (OR: 0.66, 95% CI: 0.48-0.91) and decreased breast sensitivity (0.67; 0.49-0.93).

CONCLUSIONS: Several symptoms thought to be related to treatment may actually be present at time of diagnosis and many treatment-related symptoms appear to decrease by 12-months. Severity appears to be modified by menopausal status and type of treatment. Our results give crucial insight for the development of effective symptom-based management and intervention along the treatment time course.

Citation Format: Clague DeHart J, Cheung-Wong L, Smith R, Flores S, Mortimer J. The City of Hope breast cancer survivorship study: A longitudinal look at symptoms. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-10-10.