Abstract P6-05-05: Patient-reported outcomes, perceptions, and knowledge about recurrence in women with high-risk hormone receptor-positive (HR+) breast cancer (BC)
Authors: Rosenberg Shoshana , Zheng Yue , Santos Katheryn , Riley Elizabeth , Meadows Hugh , Snow Craig , Hughes Melissa E. , Frank Elizabeth , Lin Nancy U. , Partridge Ann , Winer Eric , Parsons Heather A. 
Published: March 2023

Abstract
Background: Over half of HR+ BC recurrences occur &gt;5 years (y) from diagnosis (dx). While the risk of late recurrence is constant and extends for at least 20y, little is known about concerns, perceptions, knowledge, and interest in risk reduction in longer-term HR+ BC survivors.
Methods: From 1/2021-1/2022, we prospectively identified patients (pts) at Dana-Farber Cancer Institute with a history of stage II/III, HR+/HER2- BC, ≥5y from dx, without recurrence. Pts were invited to participate in a study investigating circulating tumor DNA and risk of recurrence as well as a separate, 1-time survey that assessed physical/mental health (PROMIS), dx/treatment concerns (Brief Illness Perception Questionnaire), risk perceptions, knowledge, and interest in risk reduction. “Overestimation” was defined as estimating ≥20% risk based on the response to the question: “If 100 women with HR+ BC are treated according to recommended guidelines, about how many will have BC come back in the 5-10y following completion of active treatment.” Descriptive statistics included medians and proportions. Logistic regression identified factors associated with overestimation of 5-10y metastatic recurrence risk.
Results: Among 166 women (of 209 sent surveys, 79%), median age at dx was 51 (range 21-76), 4% were Hispanic and/or Black; 19% did not have a college degree. Approximately 30% had stage III disease, most received chemotherapy (72%) and radiation (81%) and over half (57%) a mastectomy. Median time from dx was 10 y (range: 5-23). Almost all (97%) reported prior (44%) or current hormonal therapy (14% tamoxifen, 39% AI). Median PROMIS anxiety (53; range: 37-73), physical (51, range: 32-68), and mental (51, range: 25-68) scores were similar to population norms (score of 50). On a 0 (not at all)-10 (extremely) scale, the median rating for concern about dx/treatment was 5; for emotional impact of dx/treatment, the median rating was 9. Regarding risk perceptions, participants estimated that on average, a median of 15 and 10 women (of 100 women) would develop a loco-regional or distant recurrence, respectively, in the 5-10y interval; 43% and 40% estimated the risk of loco-regional and distant recurrence as ≥20%, respectively, for this interval. Pts without a college degree were more likely to overestimate 5-10y distant recurrence risk (multivariable OR: 3.66, 95% CI: 1.56, 8.59); age, chemotherapy receipt, surgery type, stage, and grade were not associated with overestimation. When asked, on average, which women have a higher chance of BC returning after 5y, 17% correctly responded HR+; 42% responded triple negative and 41% responded the risk was the same for both. While &gt;1/3 responded they believed alcohol in moderation may decrease the risk of BC coming back, most also responded that having a healthy weight, eating ≥5 fruits/vegetables a day, and exercise may decrease this risk, with over half reporting engagement in these behaviors (Table).
Conclusion: While most longer-term stage II/III HR+ BC survivors report mental and physical health commensurate to population norms, inaccurate knowledge and perceptions about recurrence are common. Strategies to effectively communicate risk (e.g., pictograms, decision/conversation aids) and risk reduction information can promote an accurate understanding of risk in the setting of longer-term HR+ BC survivorship, potentially mitigating emotional concerns which are prevalent ≥5y post-dx. The association between lower educational attainment underscores the importance of attention to literacy and numeracy when developing interventions to improve risk communication.
Table. Perceived impact of health behaviors on recurrence risk.
Citation Format: Shoshana Rosenberg, Yue Zheng, Katheryn Santos, Elizabeth Riley, Hugh Meadows, Craig Snow, Melissa E. Hughes, Elizabeth Frank, Nancy U. Lin, Ann Partridge, Eric Winer, Heather A. Parsons. Patient-reported outcomes, perceptions, and knowledge about recurrence in women with high-risk hormone receptor-positive (HR+) breast cancer (BC) [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 P6-05-05.