Symptom burden among older breast cancer survivors: The Thinking and Living With Cancer (TLC) study

Abstract

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.

Problems in living among breast cancer survivors

“…Taken overall, the results of this study, when combined with findings from previous reports [ 2 , 10 ], highlight the need for caregivers to emphasize screening for and discussion of symptoms, including sleep difficulties, fatigue, loss of strength, aches and pains, and muscle or joint stiffness. Of particular concern are younger survivors and those who are African American or low-income.…”

“…Important correlates of having reported symptoms included age, race, marital status, and household income. Madelblatt et al [ 10 ] noted that older breast cancer survivors may have a high symptom burden due to comorbidities and aging. However, in the current study, almost all of the symptoms were more likely to be reported by participants who were less than 55 years of age.…”

Older adult participation in cancer clinical trials: A systematic review of barriers and interventions

“…Several cohort studies were used to develop clinical risk‐prediction models, such as the CARG Chemotherapy Toxicity Score and the Chemotherapy Risk Assessment Scale for High‐Age Patients (CRASH) Score 20,34,35 . Similarly, longitudinal cohort studies can provide important insights into the late‐term effects of cancer treatment on aging in older cancer survivors, as has been done in the Thinking and Living With Cancer (TLC) Study (ClinicalTrials.gov identifier NCT03451383) 80 …”

A 4-Month Whole-Systems Ayurvedic Medicine Nutrition and Lifestyle Intervention Is Feasible and Acceptable for Breast Cancer Survivors: Results of a Single-Arm Pilot Clinical Trial

“…Receipt of chemotherapy was an inclusion criterion because these patients are more likely to have residual symptoms and impairments in QOL. 62 , 63 Of the participants who enrolled, there was high retention (84%, n = 27 of 32). Study visit attendance among those retained was nearly 100%, which is an indication of strong adherence and participant engagement throughout the intervention despite the fact that 91% were employed and working at the time of study entry.…”