Abstract P6-12-20: Impact of symptom burden on employment and quality of life in long-term Mexican breast cancer survivors treated in a tertiary referral center
Authors: Remolina-Bonilla YA , León-Rodríguez E , Armengol-Alonso A 
Published: February 2018

Abstract
Background: The number of cancer survivors has increased worldwide during the last decade as a result of improvements in the Clinical Oncology Practice. Last year, more than 15.5 million cancer survivors were alive in the United States;3.5 million were breast cancer survivors (BCS). According to GLOBOCAN 2012, breast cancer incidence in Mexico was 24.8 per 100.000. Studies in Mexican breast cancer patients have reported a five-year overall survival of 80%, expecting 16.000 BCS and 66% of unemployment rates, however, associated factors remain unknown. The aim of this study was to associate symptom burden with employment and quality of life (QOL) in long-term breast cancer survivors (LTBCS)
Patients and methods: A cross-sectional cohort study was performed including 54 patients with history of non-metastatic invasive breast cancer. Inclusion criteria were: ≤ 65 years and ≥ 2 years from diagnosis and off treatment and exclusion criteria was illiteracy. A written questionnaire (Quality of Life-Cancer Survivors, QOL-CS) developed by City of Hope National Medical Center (Spanish version) was used to measure QOL, including 41 items representing four domains: psychological well-being (18 items), physical well-being (8 items), social well-being (8 items), and spiritual well-being (7 items). Items were rated on a scale of 0 (worst outcome) to 10 (best outcome). Information was analyzed using SPSS v.21. A logistic regression was done to predict the impact of the independent variables.
Results: Median age at diagnosis and at the time of the questionnaire application was 50 and 56 years, respectively. The median survival time from diagnosis was 5 years (percentile 25-75 = 3-8.2 years). Stages were: cTNM stage I 18 (33%), stage II 28 (52%), and stage III 8 (15%). Patients received the following treatment: 26 (48%) underwent conservative surgery, 28 (52%) mastectomy; 40 (74%) chemotherapy, 34 (63%) radiotherapy, and 41 (76%) hormonal therapy. Educational attainment was less than college completion in 38 (70%) patients; disease-related work loss in 15 (27.8%), 26 (48.1%) were unemployed, and 18 (33.3%) worked half time. In employed patients the average monthly self-reported income was US $ 300 dollars. A univariate comparison between QOL-CS scores from the National Coalition from Cancer Survivorship (NCCS) and our study found significant differences. Cancer treatment distress (OR 30.5 CI 95% 2.1-437.6 p=0.01) and family distress (OR 16.4 CI 95% 1.0-260.6 p=0.04) were associated with a worst score in the QOL-CS tool. Symptoms such as menstrual change/fertility (OR 1.36 CI 95% 1.04-1.77 p=0.02), physical appearance (OR 1.36 CI 95% 1.01-1.82 p=0.03), and self-concept (OR 1.36 CI 95% 1.00-1.84 p=0.04), were associated with disease-related work loss.
Conclusion:This is one of the first studies that associates symptom burden with employment and QOL in LTBCS in Mexico. Although its limitations (small sample size), the present study highlights the need to carry out specific research to investigate the local needs in order to design public policies to subsequently improve the impact on QOL and employment in these patients in Latin America.
Citation Format: Remolina-Bonilla YA, León-Rodríguez E, Armengol-Alonso A. Impact of symptom burden on employment and quality of life in long-term Mexican breast cancer survivors treated in a tertiary referral center [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 P6-12-20.