Background: Roughly 20% of people diagnosed with breast cancer (BC) will be considered HER2+. HER2+ BC patients are among those at highest risk for developing brain metastases, with up to 50% developing brain metastases. Brain metastases are associated with faster disease progression, shorter survival, and myriad increased impairments. Despite the significant burden faced by HER2+ BC patients living with brain metastases (BMBC), there is little empirical research available regarding the unique experiences of this population. The goals of this exploratory study were to examine the feasibility of recruiting HER2+ BMBC patients to complete an online survey, and to describe their health-related quality of life (HRQOL) and experiences with work impairment. Methods: 62 women with HER2+ metastatic BC were recruited via advocacy partners, Living Beyond Breast Cancer and Metastatic Breast Cancer Alliance, and completed an online survey in January 2022. Participants reported sociodemographics, clinical history, current caregiving support received, physical health (Patient-Reported Outcomes Measurement Information System (PROMIS) Global Physical Health 2av1.2), HRQOL (PROMIS-29v2.0 and PROMIS Cognitive Function Short Form 8a) and work impairment (Work Productivity and Activity Impairment Questionnaire–Specific Health Problem (WPAI-SHPv2.0)). Descriptive statistics were calculated for study variables; PROMIS measures were converted to T scores (M=50, SD=10), enabling comparisons to established population benchmarks. Results presented in this study are restricted to the 30 HER2+ participants living with BMBC. Results: Participants were 47% White, 23% Hispanic, 23% Asian, 3% Black/African American, 3% American Indian/Alaska Native; mean age=43y (range: 33-72); 83% held a Bachelor degree or higher; 70% were married or partnered; mean years since BMBC diagnosis=2.7 (range: < 1-20); mean years between diagnosis and onset of metastatic disease=1.8 (range: 0-11). 67% of participants reported receiving constant care from a caregiver; the remaining participants reported receiving an average of 10.2 hours/week of care. 50% of participants reported physical health corresponding to poor levels (>2 SD on PROMIS). The majority of participants reported HRQOL impairments corresponding to moderate to severe levels (>1SD on PROMIS): Anxiety (84%); Physical Function (80%); Pain Interference (77%); Depression (70%); Fatigue (70%); Sleep Disturbance (67%); Cognitive Function (63%); and Ability to Participate in Social Roles and Activities (53%). Mean symptom burden T-scores (range: 60.4-67.7) and mean functional impairment T-scores (range: 36.0-39.9) were poorer relative to several reference groups (i.e., other women with HER2+ MBC, overall BC population benchmarks, general US population benchmarks). At the time of the survey, 73% of participants were not employed due to disability. Among those employed (n=7); 100% reported that BMBC negatively affected their employment in the past week: mean percent of scheduled work hours missed=37% (range: 14-74%); mean percent of reduced productivity while working=39% (range: 0-80%); and mean overall work impairment=60% (range: 39-95%). Conclusions: HER2+ BMBC patients experience substantial emotional, physical, social, and cognitive quality of life impairments, high work absenteeism, reduced productivity, and overall work impairment, suggesting significant unmet needs for this population. Efforts to recruit HER2+ BMBC patients were successful, suggesting high feasibility of future work with a more robust sample. Despite the small sample size, our descriptive results provide a key foundation for future research with HER2+ BMBC patients to formally test hypotheses and evaluate predictor variables impacting patient HRQOL and work impairment. Citation Format: Victoria G. Morris, Alexandra K. Zaleta, Heather Badt. Health-Related Quality of Life and Work Impairment Among Individuals Living with HER2+ Breast Cancer with Brain Metastases [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 P4-05-04.

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Background The COVID-19 pandemic presents a unique, amplified threat to those living with a cancer diagnosis, but personal factors may play a role in how this affects well-being. This cross-sectional study (1) describes the impacts of COVID-19 on cancer patients’ lives, and (2) explores the extent to which specific impacts of COVID-19 and noted protective factors, hope and resilience, predict two crucial patient-reported outcomes, depression and anxiety, after controlling for relevant sociodemographic and clinical factors. Methods 520 cancer patients and survivors in the U.S. completed an online survey during the first year of the pandemic and answered questions about COVID-19 areas of impact, psychological well-being, hope, and resilience. Hierarchical regression analyses were used to analyze the unique impact of each group of variables on patient-reported levels of depression and anxiety during the pandemic. Results Participants strongly endorsed COVID-19 impact across several areas of life, especially social activity, well-being, and ability to acquire basic essentials. Regression models explained a substantial amount of variance in patient-reported depression (R2 = .50, p < .001) and anxiety (R2 = .44, p < .001), revealing COVID-19 financial impact as a significant predictor of depression (β = 0.07), and COVID-19 family impact as a significant predictor of anxiety (β = 0.14), even after controlling for the effects of relevant sociodemographic and clinical variables. Additionally, resilience and hope were the largest predictors of both depression (β = − 0.19 and − 0.37, respectively) and anxiety (β = − 0.18 and − 0.29), suggesting that they account for unique variance in patient-reported mental health during the COVID-19 pandemic and might serve as important protective factors. Conclusions The current results add to existing literature documenting the significant effect of COVID-19 on those living with cancer. COVID-19 impact, including financial and family well-being, as well as positive psychological constructs, hope and resilience, play a crucial role in levels of patient-reported depression and anxiety during the pandemic. As COVID-19 continues to evolve, health care providers should routinely assess psychological well-being and needs related to COVID-19 financial and family impact in an effort to appropriately align individuals with resources and support, and consider how hope and resilience can be fostered to serve as psychological buffers during this time.

Introduction. Despite the fact that thousands of cancer clinical trials (CCTs) are available today, engagement remains low, with only 2-7% of patients with cancer participating in CCTs. Research has shown that this may partially be due to fear-based perceptions around CCTs. Unfortunately, depression and anxiety, two psychological factors that are highly prevalent in the cancer space, are known to bias attention in ways that alter perceptions and are specifically known to amplify fear-based perceptions. Thus, the purpose of this exploratory study was to examine the relationship between depression, anxiety, and perceptions of clinical trials among patients with hematologic cancer. Method: In this observational, cross-sectional study, 625 patients with hematologic cancer (46.4% multiple myeloma; 19.5% CLL; 11.4% non-Hodgkin lymphoma; 4.0% AML; 3.5% Hodgkin lymphoma; 3.2% CML; 1.6% ALL; 1.3% MPN; 7.4% other lymphoma; 1.8% other leukemia) completed the Cancer Support Community's online survey, the Cancer Experience Registry®. Participants provided sociodemographic and clinical history information, rated their level of agreement (0 = strongly disagree to 4 = strongly agree) with 8 statements related to beliefs about CCTs, and completed the Anxiety and Depression subscales (4 items each rated 1 = never to 5 = always) from the Patient-Reported Outcomes Measurement Information System (PROMIS-29v2.0). Responses to these 8 PROMIS items were averaged to compute a combined depression and anxiety score on a 5-point Likert scale. To understand the impact of depression and anxiety on perceptions of CCTs, 8 hierarchical regression models were examined; the dependent variable for each model was one of the CCT perception variables. Clinical history (cancer diagnosis, time since diagnosis, type of cancer care facility) and sociodemographic variables (age, gender identity, income, educational attainment, race, ethnicity, geographic area) were controlled for. Results: The sample was 54.9% female, 86.7% Non-Hispanic White, 60.1 years old on average (SD=10.8) and had an average time since diagnosis of 5.3 years (SD=5.3; Median = 3.0 years; IQR = 6 years). 67.7% had a college degree, 20.5% had a gross annual household income of $100,000 or above, 41.4% received cancer treatment at an academic or comprehensive cancer center, and 45.6% lived in a suburban area. Participants' average anxiety and depression score was 1.91 (SD=.93). Hierarchical regression analyses demonstrate that depression and anxiety had a significant effect on 7 of the 8 CCT perceptions assessed, when controlling for sociodemographic and cancer characteristics. Specifically, depression and anxiety were significant predictors of participants' perceptions that, "I would be unable to fulfill trial requirements due to logistical barriers" (ΔR 2=.019, b=.19, p=.003), "I don't trust the medical establishment and fear I will be used as a 'guinea pig'" (ΔR 2=.017, b=.17, p=.006), "I am uncomfortable with being randomly assigned" (ΔR 2=.016, b=.19, p=.01), "I fear receiving a placebo (for example, a sugar pill) in a clinical trial" (ΔR 2=.012, b=.18, p=.024), "I don't understand what clinical trials are" (ΔR 2=.011, b=.13, p=.021), "There are no clinical trials available in my community" (ΔR 2=.010, b=.14, p=.030), and "I fear side effects that might come with treatment on a clinical trial" (ΔR 2=.009, b=.13, p=.047). Thus, depression and anxiety accounted for significant amounts of variance in each of these clinical trial perceptions above and beyond the controls. Depression and anxiety did not have a significant impact on participants' perceptions that their health insurance would not cover a CCT (ΔR 2=.002, b=.05, p=.370). Conclusion. Our findings demonstrate small but significant relationships between depression, anxiety, and perceptions of CCTs among patients with hematologic cancer. While common attempts to alter CCT perceptions often focus on information dissemination, the present study indicates that psychological factors may also need to be considered. While this study is an important first step in considering the relationship between mental health and perceptions of CCT, further longitudinal research is needed to better elucidate these findings. For example, differential analyses should explore if and how these relationships differ among patients with pre-existing clinically-significant levels of depression and anxiety. Disclosures LeBlanc: AbbVie: Consultancy, Honoraria, Other: Advisory board; Travel fees, Speakers Bureau; Flatiron: Consultancy, Other: Advisory board; AstraZeneca: Consultancy, Honoraria, Other: Advisory board, Research Funding; Daiichi-Sankyo: Consultancy, Honoraria, Other: Advisory board; UpToDate: Patents & Royalties; Pfizer: Consultancy, Other: Advisory Board; CareVive: Consultancy, Other, Research Funding; NINR/NIH: Research Funding; Helsinn: Consultancy, Research Funding; Agios: Consultancy, Honoraria, Other: Advisory board; Travel fees, Speakers Bureau; Astellas: Consultancy, Honoraria, Other: Advisory board; Seattle Genetics: Consultancy, Other: Advisory board, Research Funding; Jazz Pharmaceuticals: Research Funding; Otsuka: Consultancy, Honoraria, Other; BMS/Celgene: Consultancy, Honoraria, Other: Travel fees, Research Funding, Speakers Bureau; Amgen: Consultancy, Other: travel; Heron: Consultancy, Honoraria, Other: advisory board; American Cancer Society: Research Funding; Duke University: Research Funding.