P5-17-07: HER2+ Metastatic Breast Cancer Patient Experiences on Treatment in the Biologic Era: Findings from a Community Web-Based Survey.
Authors: Mayer M , Doan JF , Lang K , Hurvitz SA , Lalla D , Woodward RM , Brammer MG , Menzin J , Tripathy D 
Published: June 2012

Background: HER2−directed biologic therapy is part of recommended treatment for women with HER2+ metastatic breast cancer (MBC). However, little is known regarding the quality of life (QoL) experience and symptom burden in these women outside of clinical trials.

Methods: This one-time, web-based survey was conducted with 6 independent U.S. breast cancer support groups. Respondents were required to be female, aged 18+ with HER2+ MBC, and to have received active treatment in the past month outside of a clinical trial. Data were collected on demographic, clinical, employment, QoL (Rotterdam Symptom Checklist and EQ-5D), and other measures. Survey responses were stratified by active treatment (biologic alone, biologic in combination with other therapy, no biologic) and number of months since diagnosis of MBC.

Results: Of 337 possible respondents, 185 women with HER2+ MBC completed the survey. The majority were aged 45–59 years (53.5%), white (94.6%), living with a spouse or partner (74.6%), and had at least some college education (93.5%). Most (64.9%) reported bone as a site of metastasis, followed by liver (36.2%), lung (31.9%), and brain (21.6%). During the prior month, 60 respondents (32.4%) had received biologic therapy only (trastuzumab, lapatinib and/or bevacizumab), 93 (50.3%) received biologic with another treatment, 21 (11.4%) received no biologic and 11 (5.9%) did not report a specific active treatment. Demographic and clinical characteristics were similar across therapy groups, with some geographic variation. Overall, the tumor receptor status was ER+/PR+ for 43.2% of respondents. Mean months since MBC diagnosis ranged from 46 among those taking a biologic with another treatment to 60 for those taking biologics only. Average Rotterdam subscale scores indicate that psychological symptoms caused the greatest impairment (mean= 67.8 of 100, where 100 is best), followed by physical symptoms (74.1) and activity limitations (87.3). There were no clinically meaningful (≥8 point) differences across biologic groups, with the greatest difference between the biologic with other therapy (73.5) and biologic-only (80.8) groups for “overall evaluation of life.” The average EQ-5D utility index score was 0.8 (1.0 is perfect health), with minimal variation across therapy groups. Most respondents reported no problems with mobility (62-77%) or self-care (≥90% across groups). However, pain/discomfort and anxiety/depression were problematic for more than 50% of all respondents, and were most commonly reported among the biologic plus other treatment group (61.3% and 51.6% respectively, P&lt;.05 for differences in usual activity problems). Rotterdam and EQ-5D dimension scores indicated less impairment with more time since MBC diagnosis, particularly for EQ-5D mobility, self-care, usual activities, and pain/discomfort. Pain and mobility scores for those diagnosed 72+ months ago were significantly better than for those diagnosed 0–17 months ago (both P&lt;.05).

Conclusions: This community survey of women with HER2+ MBC provides valuable insight into treatment, quality of life and symptom burden. Pain and psychological issues continue to be challenges for this population.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-17-07.