Little has been said about the residual and persistent side effects of breast cancer treatment. Treatment advances have increased the five-year survival rate for
breast cancer to 90%.
But, for many of the 2.8 million survivors
in the United States, the price of survival includes severe physical and
psychosocial symptoms - including joint pain, fatigue, weight gain and
insomnia - that may go untreated and persist for many years after
‘Healthcare providers should think about the residual and persistent side effects of breast cancer treatment and guide these patients to services that can help improve their quality of life on multiple levels.’
Long-term survivors report an average three symptoms for
which they desire more help than they are receiving, suggested a new
research from the Perelman School of Medicine and the Abramson Cancer
Center of the University of Pennsylvania.
Additional results show a
significant relationship between untreated symptoms and anxiety and
depression among these patients. Researchers are calling on health care
providers to think beyond the disease, and incorporate symptom
management more frequently into routine follow-up care.
"There's almost an unwritten 'don't ask, don't tell' mentality about
residual and persistent side effects of breast cancer treatment," said
lead author Steven Palmer, a research scientist at the Abramson
Cancer Center. "Clinicians seeing patients for routine follow-up care
may be focusing on recurrence prevention and detection to the exclusion
of long term symptoms and whether survivors need help managing them.
This lack of attention to potential symptoms can lead to increased
levels of anxiety and depression for these cancer survivors."
In the study, 103 breast cancer survivors who have been disease-free
for at least three years completed surveys assessing the prevalence and
severity of 19 symptoms and whether they would like help managing
those symptoms. Anxiety and depressive symptoms were also reported by
participants using the Hospital Anxiety and Depression Scale.
Results show 92% of survivors reported at least three
long-term symptoms, primarily fatigue, aching joints, weight gain,
memory trouble, or insomnia, while 65% had at least one unmet
need for intervention, with the average survivor reporting three unmet
Additional results show that breast cancer survivors living with
more needs for symptom management are also more likely to experience
anxiety and depression. The researchers suggest that when extended to
the larger breast cancer survivor population, more than 1,300,00 breast
cancer survivors could be experiencing at least three specific symptoms
for which they need assistance.
Services to assist with survivorship care are becoming more
commonplace, but the authors suggest that for many patients, long term
symptoms go unaddressed in either cancer or primary care settings, and
appropriate treatments and referrals are not being made.
"Survivorship care is about more than screenings and disease
prevention. It's about the whole person," said senior author Linda A.
Jacobs, director of Cancer Survivorship Programs at Penn's
Abramson Cancer Center. "Our results point to a need for a more holistic
view of breast cancer care where providers are thinking about what
happens next for these patients and guiding them to services that can
help improve their quality of life on multiple levels."