High Symptom Burden and Lower Levels of Well-Being Found Among Survivors of Breast Cancer


A recent study showed survivors aged 60 and older of newly diagnosed nonmetastatic breast cancer reported lower levels of overall well-being and higher levels of symptom burden because of cancer and its treatment.

In older breast cancer survivors, a higher level of symptoms and greater loss of well-being over time is associated with cancer and its treatments, according to a study published in Cancer.

The adjusted burden score was highest among chemotherapy-exposed survivors, with the most notable differences in symptoms between survivors and the control group being cognitive and sleep problems, anxiety, and neuropathy.

“Over the 36 months after diagnosis, older breast cancer survivors have a higher symptom burden than that observed in similar older women without cancer,” wrote Jeanne S. Mandelblatt, MD, MPH, and colleagues. “The highest magnitude of effect of treatment on symptom burden was seen for those exposed to chemotherapy (with or without hormone therapy), but those on hormone therapy alone also had a significantly greater symptom burden than women without cancer.”

The researchers reported that eligible survivors were aged 60 or older and had newly diagnosed nonmetastatic breast cancer. The total number included 362 survivors and 365 controls. In total, 74.5% 73%, and 65% of survivors and 87.8%, 79.9%, and 70.2% of control participants completed the 12-month, 24-month, and 36-month assessments, respectively.

Of both the survivor and control groups, participants were aged between 60 and 98 years old. Those survivors who received chemotherapy tended to have highest levels of peripheral neuropathy, depression, and pain. Further, symptom burden was also greatest in those who received chemotherapy with or without hormone therapy (P < .001). Although lifestyle did not have a significant impact on treatment-group effect, higher amounts of physical activity reduced symptoms (P = .04).

Even more, well-being was measured as a focal point of this study. The researchers determined that, when symptom burden was higher than a woman’s usual level or other women, that correlated with a worse well-being score (P < .001). Specifically, when a woman had a greater symptom burden, her adjusted physical well-being scored dropped by 12.4 points (P < .001). That being said, greater physical activity correlated with greater physical and functional well-being (P < .004).

“By including a noncancer group, we were able to demonstrate that older breast cancer survivors experienced a higher burden of symptoms and greater decrement in function than controls,” wrote Mandelblatt and colleagues. “These findings could inform long-term clinical care to address the persistent effects of treatment because symptoms could affect the completion of hormone therapy.”

The study is limited in its results, as the researchers explain their inability to find benefits for healthy lifestyles, potentially because of limitations to sensitivity and variability measures. Having explained this, the researchers emphasize that they found that being more physically active does reduce symptoms and improve well-being.

The strengths of the study start with its size and scope, with a large sample and 36 months of data collected. A noncancer control group also allowed for the researchers to make valuable inferences regarding the study’s survivor population. Future research is needed to better identify what contributes to high symptom burden and functional decline in survivors of newly diagnosed nonmetastatic breast cancer.

“Overall, this study moves the field forward by demonstrating that cancer and its treatments lead to a higher level of actionable symptom burden and greater loss of well-being over the first 36 months after diagnoses than expected based on the experience of matched noncancer controls.”


Mandelblatt JS, Zhai W, Ahn J, et al. Symptom Burden Among Older Breast Cancer Survivors: The Thinking and Living with Cancer (TLC) Study. Cancer. 10.1002/cncr.32663.

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