Abstract P6-11-12: Health-related quality of life, symptom burden and management in older women with breast cancer across the illness trajectory
Authors: Halilova KI , Williams CP , Azuero A , Kvale EA , Yagnik SK , Goertz H-P , Pizu M , Rocque GB 
Published: February 2018

Background: Symptom burden has a negative impact on Health-Related Quality of Life (HRQoL). Identifying symptom burden and sources utilized for symptom management at different points in the cancer trajectory may guide development of supportive care services for older patients with breast cancer.

Methods: This was secondary analysis of survey data from the University of Alabama at Birmingham Health System Cancer Community Network, which includes 12 hospitals across the Southeast. Female Medicare beneficiaries with breast cancer were surveyed from 2013-2015 via telephone. Demographic information, treatment status, HRQoL (Short Form Health Survey, SF-12), symptom burden (MD Anderson Symptom Inventory, MDASI), and sources used for symptom management (e.g. doctors, nurses) were collected. Descriptive statistics were computed for all variables of interest. HRQoL, overall symptom burden, and individual symptom scores by treatment status were compared using standardized mean differences (Cohen's d) and Student's t-tests. Simple linear regression was used to determine the association between symptom burden and HRQoL scores. A 10% False-Discovery-Rate was used to adjust for multiple inference.

Results: 321 women age 65 years and older with breast cancer were included in the survey sample; 141 (45%) were on treatment with chemotherapy (9%), radiation (1%), recurrence treatment (6%), or other planned cancer treatment (29%). Similar HRQoL scores were observed for participants on and off treatment, with SF-12 physical scores of 39.2 (SD 11.5) vs. 41.4 (SD 11.9, d=.19) and SF-12 mental scores of 52.5 (SD 9.7) vs. 53.2 (SD 9.4, d=.07). Symptom burden was also similar, with overall MDASI severity scores of 2.5 (SD 1.9) and 2.2 (SD 1.7, d=.17). For participants on treatment, fatigue and disturbed sleep were the most severe symptoms with average scores of 4.4 (SD 3.0) and 3.6 (SD 3.2), respectively. For participants off treatment, the most severe symptoms were fatigue and memory problems with average scores of 3.8 (SD 3.1) and 3.1 (SD 2.7). A small difference in disturbed sleep was observed, with participants on treatment reporting more symptom severity (3.6 [SD 3.2] vs 2.7 [SD 2.9], d=.3, p=.01). Minor differences were observed for the severity of other specific symptoms between the groups. For patients both on and off treatment, MDASI scores were strongly and significantly associated with decreased SF-12 physical (on: β=-3.0 [SE 0.4], R2=.21, p&lt;.001; off: β=-3.8 [SE 0.4], R2=.34, p&lt;.001) and SF-12 mental scores (on: β=-3.1 [SE 0.3], R2=.34, p&lt;.001; off: β=-3.1 [SE 0.3], R2=.34, p&lt;.001). The three most common sources to manage symptoms used by participants in both groups were nurses (47%), doctors (26%), and friends/neighbors (26%).

Conclusion: Quality of life and overall symptom burden were similar for patients on and off treatment, with only a small difference in disturbed sleep. Overall symptom burden was strongly associated with decreased HRQoL among older females with breast cancer. Nurses were the most common source utilized for symptom management, suggesting the importance of systematic trainings, particularly for nurses, on symptom management and supportive care services for patients on and beyond treatment.

Citation Format: Halilova KI, Williams CP, Azuero A, Kvale EA, Yagnik SK, Goertz H-P, Pizu M, Rocque GB. Health-related quality of life, symptom burden and management in older women with breast cancer across the illness trajectory [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-11-12.