Abstract P5-12-04: Symptom Burden Declines When Breast Cancer Patients Treated with Adjuvant Trastuzumab/Combination Chemotherapy Regimens Enter Trastuzumab Monotherapy Follow-Up
Authors: Houts AC , Lalla D , Walker MS , Stepanski EJ , Brammer M , Doan JF , Schwartzberg LS. 
Published: April 2011

Abstract
Background: Trastuzumab (T) is indicated for the adjuvant treatment of HER2-overexpressing breast cancer (BC). We report the results of a retrospective study of patient-reported outcomes (PROs) for patients who received T plus chemotherapy followed by T monotherapy or T as a single-agent.
Methods: Included in this analysis were 210 patients with early HER2+ BC treated in community oncology practices affiliated with ACORN Research, who completed a 38-item symptom assessment scale, the Patient Care Monitor (PCM). Treatment regimens were classified as: combination chemotherapy followed by T monotherapy: doxorubicin, cyclophosphamide, paclitaxel [n=74] or docetaxel [n=18] and T (AC→TH/ACTH) (n=92); docetaxel, carboplatin, and T (TCH) (n = 38); or “Other” chemotherapy/T (n=47); or T only (n=33). Medical records were abstracted and symptom burden was measured by PCM index scores for: Physical Symptoms, Treatment Side Effects, Distress, Despair, Impaired Ambulation, and Impaired Performance. Linear mixed models were used to examine change in PCM index scores over time, controlling for first line chemotherapy group and relevant covariates. Results: Patients were 66% Caucasian and 28% African American. The mean age of, this cohort was 56.0 years (range=31-85 years). Demographic and disease characteristic s did not differ among the four treatment regimens except patients treated with AC→TH/ACTH tended to have higher stage of disease at time of diagnosis. Among patients on combination chemotherapy, median time on active chemotherapy was 3.5 months. Patients were observed for a median of 12.5 months. Impaired Ambulation, Impaired Performance, and General Physical Symptoms worsened over the course of active chemotherapy (p &lt; .05), whereas Treatment Side Effects were worse from the start and remained stable during active chemotherapy. When chemotherapy stopped and patients entered T monotherapy, General Physical Symptoms and Treatment Side Effects improved significantly, but showed less improvement for TCH than for the other 2 groups (p &lt; .05). Symptom burden improved during T monotherapy for TCH, AC→TH/ACTH and “Other”, generally converging with scores for patients who had T only, which tended to be lower and more stable. With the exception of younger patients showing more Distress, patient level characteristics (age, race, BMI, stage) were not significantly predictive of symptom burden trajectory and change.
Discussion: Functioning and physical symptom burden tended to worsen during active chemotherapy and to improve when active chemotherapy stopped. TCH was associated with more gradual improvement in symptom burden than AC→TH/ACTH and the “Other” combination group. Most patients treated with combination chemotherapy showed symptom burden similar to those treated with T only once they transitioned to T monotherapy as follow-up treatment.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-12-04.