Abstract PD12-09: Patient-reported outcomes of adolescents and young adults with breast cancer treated with curative intent
Authors: Krishnamurthy Revathy , Cil Tulin , Bedard Philippe , Forbes Robin , Li Madeline , Liu Zhihui (Amy) , Croke Jennifer 
Published: February 2021

Abstract
Purpose: To evaluate patient-reported outcomes of adolescents and young adults (AYAs) with breast cancer treated with curative intent.
Methods: AYA breast cancer patients (defined as diagnosed between 18 to 39 years of age) treated at a large tertiary cancer centre between January 2014 and December 2016 were identified. Patients routinely complete the validated symptom screening tool, the Edmonton Symptom Assessment System-revised (ESAS-r) prior to their clinical encounter. Scores from diagnosis up to 24 months post-diagnosis were obtained from our internal database, with elevated scores defined as &gt; 4 for each individual symptom (rated 0-10). Patient, clinical and treatment characteristics were extracted from medical records. Descriptive statistics were used to describe patient, clinical and treatment characteristics, and ESAS-r scores. Time to recurrence was calculated from diagnosis to local or regional recurrence, distant metastasis or death (whichever occurred first). Kaplan-Meier survival analysis and log-rank tests were used to compare time to recurrence between women with vs. without elevated symptom scores. Chi-squared test was used to test the change in number of patients with elevated symptom scores over time. Univariable and multivariable logistic regression models were carried out to assess association between various factors and ESAS-r symptoms of depression, anxiety and well-being within 24 months of diagnosis.
Results: Among 258 patients identified, 211 (82%) had accompanying ESAS-r and were eligible for analysis. Median follow-up was 3.9 years. Median age at diagnosis was 35 (20-39), most were clinical stage 2/3 at diagnosis (63%), 20% had triple negative disease, 76% received chemotherapy and 81% received radiotherapy. Overall, symptom burden was the highest (scores &gt; 4) for decreased well-being (52%), tiredness (48%) and anxiety (44%). Although symptom burden significantly improved over time, 43%, 38% and 33% of patients, respectively, reported elevated symptoms 24 months post-diagnosis. Multivariable analysis found that elevated anxiety was significantly associated with younger age at diagnosis (p=0.036), receipt of chemotherapy (p=0.01) and presence of long-term toxicity (p=0.0032). Elevated depression, anxiety and well-being were significantly associated with referral to Psychosocial Oncology (p=0.024, p=0.036 and p=0.019, respectively), whereas well-being was also associated with referral to Survivorship Clinic (p=0.043). However, overall rates of referral (24-36%) were much lower than symptom prevalence. There was no association between elevated symptoms and time to recurrence.
Conclusion: AYAs diagnosed with breast cancer report high symptom burden that continues to persist up to 24-months post-diagnosis. Patients with elevated psychosocial distress are more likely to be referred to Psychosocial Oncology and Survivorship clinics, indicating that the ESAS-r is a useful screening tool in a real-world setting. However, a gap between symptom burden and intervention exists, providing opportunities for future research.
Citation Format: Revathy Krishnamurthy, Tulin Cil, Philippe Bedard, Robin Forbes, Madeline Li, Zhihui (Amy) Liu, Jennifer Croke. Patient-reported outcomes of adolescents and young adults with breast cancer treated with curative intent [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PD12-09.