Abstract P5-07-10: Symptom and Functional Status for Individuals with Triple Negative Breast Cancer and Palliative Care Utilization: Findings from the Cancer Experience Registry
Authors: Popalis Madyson L. , Badt Heather , Doughtie Kara , Lawrence Caroline , Miller Melissa F. 
Published: March 2023

Background: Triple negative breast cancer (TNBC) can spread quickly and has a higher rate of recurrence than other breast cancers. Due to TNBC’s aggressive nature and treatment, patients can experience adverse symptoms and side effects. Palliative care (PC) is intended to improve health-related quality of life (HRQOL) for patients with serious disease at any stage of their illness. However, PC is often conflated with end-of-life care which can affect its rates of utilization. The goals of this study were to explore how TNBC patients characterize their HRQOL by time since diagnosis and describe the rate of utilization in the past year of PC providers for symptom and side effect management. Methods: Data was collected through Cancer Support Community’s Cancer Experience Registry® (CER). From Jan 2015 to Aug 2021, 209 individuals with TNBC enrolled in the CER and completed the Patient-Reported Outcomes Measurement Information System-29 (PROMIS-29 v2.0) profile measure. Five domains assess symptoms with higher scores corresponding to worse symptomology (depression, anxiety, pain interference, fatigue, and sleep disturbance) and two domains assess function with lower scores corresponding to worse functioning (physical and social). Scale scores were converted to standardized T scores and compared against the U.S. population (M=50, SD=10) and reference values for newly diagnosed patients with all types of breast cancer. We considered a group score difference of 3 points clinically meaningful. Moderate to severe impairments are reported as percentages of the sample that have PROMIS scores &gt;1SD from M=50. Of the 209 TNBC patients, 66 (32%) participated after Nov 2018 and answered newer survey items about utilization of PC providers in the past year. Results: Participants were mainly Non-Hispanic White (81%); resided in suburban/urban areas (84%); reported household income &gt;$40K (64%); Mean age=53y (SD=10; range 28-77). Median time since diagnosis was 2y. 25% reported advanced or metastatic disease; 41% were currently receiving treatment. TNBC patients reported elevated symptoms and deficits in functioning relative to the U.S. population (score difference&gt;3) for all PROMIS subscales except depression (M=51.9) and social function (M=48.8). Fatigue and anxiety scores were highest (M=55.3 and M=56.2, respectively) exceeding the threshold for mild severity. About one-third of participants reported moderate to severe levels of symptom impairment for fatigue (36%), anxiety (36%), and pain interference (32%). Newly diagnosed participants reported higher levels of symptom severity and functional deficits which improved over time; however, survivors’ PROMIS scores remained worse than the U.S population for fatigue and anxiety. Compared to reference values for breast cancer patients, newly diagnosed (&lt; 2y) TNBC participants (n=83) reported elevated symptoms for fatigue, anxiety, and depression and worse social function (score differences, 4.0, 9.1, 5.3, and 3.9, respectively). In the past year, 69% saw an oncology provider for symptom and side effect support, 44% saw a primary care provider, and 9% a PC provider. Some participants sought care for symptom and side effect management from allied and psychosocial providers such as pharmacists (28%), counselors (25%), and physical therapists (24%). Conclusions: Among TNBC patients, we observed higher levels, on average, of fatigue, anxiety, and depression, and lower social function compared to reference values for breast cancer patients and the U.S. population. Symptom severity and functional deficits were highest among individuals newly diagnosed with TNBC suggesting the importance of incorporating PC into cancer care early in the disease course. TNBC patients and survivors most frequently rely on primary care and oncology care teams for management of symptoms. Future research should examine access barriers to PC providers.

Citation Format: Madyson L. Popalis, Heather Badt, Kara Doughtie, Caroline Lawrence, Melissa F. Miller. Symptom and Functional Status for Individuals with Triple Negative Breast Cancer and Palliative Care Utilization: Findings from the Cancer Experience Registry [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-07-10.