Symptom burden among older breast cancer survivors: The Thinking and Living With Cancer (TLC) study.
Aged
Aged, 80 and over
Antineoplastic Agents
Antineoplastic Agents, Hormonal
/ therapeutic use
Anxiety
/ epidemiology
Breast Neoplasms
/ complications
Cancer Pain
/ epidemiology
Cancer Survivors
/ psychology
Cognition Disorders
Cohort Studies
Depression
/ epidemiology
Exercise
Fatigue
/ epidemiology
Female
Health Status
Heart Diseases
/ epidemiology
Humans
Life Style
Middle Aged
Nervous System Diseases
/ etiology
Self Report
Sleep Wake Disorders
/ epidemiology
Survivorship
Symptom Assessment
/ statistics & numerical data
Symptom Flare Up
breast cancer
older patients
survivorship
symptom burden
well-being
Journal
Cancer
ISSN: 1097-0142
Titre abrégé: Cancer
Pays: United States
ID NLM: 0374236
Informations de publication
Date de publication:
15 03 2020
15 03 2020
Historique:
received:
28
08
2019
revised:
27
09
2019
accepted:
15
10
2019
pubmed:
21
12
2019
medline:
10
10
2020
entrez:
21
12
2019
Statut:
ppublish
Résumé
Little is known about longitudinal symptom burden, its consequences for well-being, and whether lifestyle moderates the burden in older survivors. The authors report on 36-month data from survivors aged ≥60 years with newly diagnosed, nonmetastatic breast cancer and noncancer controls recruited from August 2010 through June 2016. Symptom burden was measured as the sum of self-reported symptoms/diseases as follows: pain (yes or no), fatigue (on the Functional Assessment of Cancer Therapy [FACT]-Fatigue scale), cognitive (on the FACT-Cognitive scale), sleep problems (yes or no), depression (on the Center for Epidemiologic Studies Depression scale), anxiety (on the State-Trait Anxiety Inventory), and cardiac problems and neuropathy (yes or no). Well-being was measured using the FACT-General scale, with scores from 0 to 100. Lifestyle included smoking, alcohol use, body mass index, physical activity, and leisure activities. Mixed models assessed relations between treatment group (chemotherapy with or without hormone therapy, hormone therapy only, and controls) and symptom burden, lifestyle, and covariates. Separate models tested the effects of fluctuations in symptom burden and lifestyle on function. All groups reported high baseline symptoms, and levels remained high over time; differences between survivors and controls were most notable for cognitive and sleep problems, anxiety, and neuropathy. The adjusted burden score was highest among chemotherapy-exposed survivors, followed by hormone therapy-exposed survivors versus controls (P < .001). The burden score was related to physical, emotional, and functional well-being (eg, survivors with lower vs higher burden scores had 12.4-point higher physical well-being scores). The composite lifestyle score was not related to symptom burden or well-being, but physical activity was significantly associated with each outcome (P < .005). Cancer and its treatments are associated with a higher level of actionable symptoms and greater loss of well-being over time in older breast cancer survivors than in comparable noncancer populations, suggesting the need for surveillance and opportunities for intervention.
Sections du résumé
BACKGROUND
Little is known about longitudinal symptom burden, its consequences for well-being, and whether lifestyle moderates the burden in older survivors.
METHODS
The authors report on 36-month data from survivors aged ≥60 years with newly diagnosed, nonmetastatic breast cancer and noncancer controls recruited from August 2010 through June 2016. Symptom burden was measured as the sum of self-reported symptoms/diseases as follows: pain (yes or no), fatigue (on the Functional Assessment of Cancer Therapy [FACT]-Fatigue scale), cognitive (on the FACT-Cognitive scale), sleep problems (yes or no), depression (on the Center for Epidemiologic Studies Depression scale), anxiety (on the State-Trait Anxiety Inventory), and cardiac problems and neuropathy (yes or no). Well-being was measured using the FACT-General scale, with scores from 0 to 100. Lifestyle included smoking, alcohol use, body mass index, physical activity, and leisure activities. Mixed models assessed relations between treatment group (chemotherapy with or without hormone therapy, hormone therapy only, and controls) and symptom burden, lifestyle, and covariates. Separate models tested the effects of fluctuations in symptom burden and lifestyle on function.
RESULTS
All groups reported high baseline symptoms, and levels remained high over time; differences between survivors and controls were most notable for cognitive and sleep problems, anxiety, and neuropathy. The adjusted burden score was highest among chemotherapy-exposed survivors, followed by hormone therapy-exposed survivors versus controls (P < .001). The burden score was related to physical, emotional, and functional well-being (eg, survivors with lower vs higher burden scores had 12.4-point higher physical well-being scores). The composite lifestyle score was not related to symptom burden or well-being, but physical activity was significantly associated with each outcome (P < .005).
CONCLUSIONS
Cancer and its treatments are associated with a higher level of actionable symptoms and greater loss of well-being over time in older breast cancer survivors than in comparable noncancer populations, suggesting the need for surveillance and opportunities for intervention.
Identifiants
pubmed: 31860135
doi: 10.1002/cncr.32663
pmc: PMC7255412
mid: NIHMS1590187
doi:
Substances chimiques
Antineoplastic Agents
0
Antineoplastic Agents, Hormonal
0
Types de publication
Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1183-1192Subventions
Organisme : NCI NIH HHS
ID : T32 CA117865
Pays : United States
Organisme : NCI NIH HHS
ID : P30 CA008748
Pays : United States
Organisme : NCI NIH HHS
ID : R01 CA129769
Pays : United States
Organisme : NCI NIH HHS
ID : R01 CA214647
Pays : United States
Organisme : NCI NIH HHS
ID : F31 CA220964
Pays : United States
Organisme : NCI NIH HHS
ID : R35 CA197289
Pays : United States
Organisme : EPA
ID : EP-D-17-023
Pays : United States
Organisme : NCI NIH HHS
ID : U54 CA137788
Pays : United States
Organisme : NCI NIH HHS
ID : R01 CA219389
Pays : United States
Organisme : NCI NIH HHS
ID : R01 CA164109
Pays : United States
Organisme : EPA
ID : EP-C-17-023
Pays : United States
Organisme : NCI NIH HHS
ID : R01 CA172119
Pays : United States
Organisme : NCI NIH HHS
ID : U54 CA132378
Pays : United States
Organisme : NCI NIH HHS
ID : P30 CA051008
Pays : United States
Informations de copyright
© 2019 American Cancer Society.
Références
J Clin Oncol. 2016 Feb 20;34(6):611-35
pubmed: 26644543
J Clin Oncol. 2018 Oct 3;:JCO1800140
pubmed: 30281396
J Pain Symptom Manage. 2019 Mar;57(3):596-606
pubmed: 30472317
Qual Life Res. 2018 Aug;27(8):2077-2086
pubmed: 29740782
J Oncol Pract. 2019 Feb;15(2):e98-e109
pubmed: 30550372
Am J Epidemiol. 2018 Mar 1;187(3):568-575
pubmed: 29165572
J Clin Oncol. 2014 Jun 20;32(18):1909-18
pubmed: 24841981
Breast Cancer Res Treat. 2018 Jan;167(1):157-169
pubmed: 28861642
In Vivo. 2019 May-Jun;33(3):881-888
pubmed: 31028212
Cancer Epidemiol Biomarkers Prev. 2016 Jul;25(7):1029-36
pubmed: 27371756
J Clin Oncol. 2007 Sep 1;25(25):3991-4008
pubmed: 17577017
Lancet Oncol. 2011 Jul;12(7):703-8
pubmed: 21354373
J Pain Symptom Manage. 1997 Feb;13(2):63-74
pubmed: 9095563
J Natl Cancer Inst. 2013 Oct 16;105(20):1579-87
pubmed: 24096621
J Clin Oncol. 2019 Jul 1;37(19):1666-1676
pubmed: 31100037
Breast J. 2018 Mar;24(2):167-175
pubmed: 28845551
Breast Cancer Res Treat. 2018 Aug;170(3):455-476
pubmed: 29654416
J Clin Oncol. 2008 Aug 20;26(24):3958-64
pubmed: 18711185
J Am Geriatr Soc. 2017 Oct;65(10):2285-2289
pubmed: 28857119
Eur J Cancer Care (Engl). 2019 Jul;28(4):e13037
pubmed: 30895677
Psychooncology. 2012 Feb;21(2):176-86
pubmed: 22271538
JAMA Intern Med. 2014 Mar;174(3):399-407
pubmed: 24276929
J Clin Oncol. 2014 Aug 20;32(24):2617-26
pubmed: 25071135
Psychooncology. 2019 May;28(5):997-1003
pubmed: 30761683
BMC Cancer. 2019 Apr 23;19(1):371
pubmed: 31014267
Psychooncology. 2019 Jul;28(7):1430-1437
pubmed: 30980431
J Breast Cancer. 2016 Dec;19(4):447-454
pubmed: 28053634
Cancer. 2019 Jun 15;125(12):1979-1989
pubmed: 30933317
J Geriatr Oncol. 2016 Jul;7(4):270-80
pubmed: 27197918
J Gerontol A Biol Sci Med Sci. 2001 Mar;56(3):M146-56
pubmed: 11253156
J Clin Oncol. 1993 Mar;11(3):570-9
pubmed: 8445433
Health Qual Life Outcomes. 2003 Dec 16;1:79
pubmed: 14678568
J Health Soc Behav. 2010;51 Suppl:S28-40
pubmed: 20943581
J Natl Cancer Inst. 2014 Apr;106(4):dju057
pubmed: 24681605
Breast Cancer Res Treat. 2017 Nov;166(2):519-526
pubmed: 28791499
Cancer Nurs. 2020 Mar/Apr;43(2):134-146
pubmed: 30543571