Understanding breast cancer (BC) from the patient (pt) perspective: A qualitative study of symptoms, impacts and health-related quality of life (HRQoL) in hormone receptor-positive, HER2-negative (HR+, HER2–) BC.
Authors: Kovic Bruno , Steenrod Anna , Kosmas Charlotte E. , Lanar Sally , Gilham Leslie , Lavallé Sandrine , Španić Tanja , Lambertini Matteo , Chavez-MacGregor Mariana 
Published: June 2024

e23184

Background: HR+, HER2– is the predominant BC subtype. Treatment (tx) options across stages are broad; however, there are limited published qualitative data providing insights on pt disease and tx experiences to inform healthcare decision-making. This study aimed to identify the most important disease- and tx-related symptoms and impacts on HRQoL, including exploring how bothersome and worrisome symptoms were, and attribution to tx and disease, in HR+, HER2– early (e) and metastatic (m)BC. Methods: This was an international qualitative study with pt steering committee input. Individual pt concept elicitation interviews were conducted (until saturation). Interviews were audio-recorded, translated into English, transcribed, and anonymized. Transcripts were coded and analyzed thematically. Two pt-centered conceptual models were developed to summarize data for eBC and mBC. Results: Twenty-four female pts (12 eBC; 12 mBC), aged 33–70 yrs old, were interviewed; 17 were postmenopausal. The most common tx was hormone therapy (n = 10) in eBC and cyclin-dependent kinase 4/6 inhibitors (n = 7) in mBC. The most frequently reported symptoms were fatigue (eBC n = 11; mBC n = 10) and pain (eBC n = 9; mBC n = 11). In eBC, fatigue was ranked most bothersome (n = 3) and pain most worrisome (n = 3). In mBC, pain was ranked most bothersome and worrisome (n = 7). In eBC, sleep problems, hot flashes, and difficulty concentrating/brain fog were also frequently reported (≥50% of pts) and ranked most bothersome. In mBC, sleep problems and hot flashes were also frequently reported (≥50% of pts), with hot flashes ranked most bothersome; nausea was less frequently reported but ranked most bothersome by two pts. The majority of pts with eBC attributed their most frequently reported symptoms to tx, whereas pts with mBC attributed them to tx alone or tx and their disease. The most frequently reported impacts in eBC were limited exercise/strenuous activity (n = 10), and fatigue, difficulty concentrating, and anxiety (n = 9 each). The most frequently reported impacts in mBC were limited participation in social activities (n = 10), and difficulties with activities of daily living, trouble with mobility, anxiety, and frustration (n = 9 each). Conclusions: These qualitative data highlight similarities in pt symptoms across eBC and mBC (pain and fatigue), with differences in symptom attribution. Compared with eBC, pts with mBC had greater physical functioning impairment and may have experienced more disease-related symptoms. Overall, these data improve understanding of pts’ experience in HR+, HER2– BC, identify the distinct and clinically relevant concepts most important to them, and can help to optimize the selection and development of pt-reported outcomes in research and clinical practice to further inform treatment decision-making.