TY - JOUR

T1 - The long-term burden of a symptom cluster and association with longitudinal physical and emotional functioning in breast cancer survivors

AU - Ebbestad, Freja Ejlebæk

AU - Ammitzboll, Gunn

AU - Horsboll, Trine Allerslev

AU - Andersen, Ingelise

AU - Johansen, Christoffer

AU - Zehran, Bo

AU - Dalton, Susanne Oksbjerg

PY - 2023

Y1 - 2023

N2 - BackgroundFatigue, insomnia and pain are some of the most common and distressing symptoms experienced during breast cancer (BC) treatment and survivorship. The symptoms have been found to impact one another and to form a symptom cluster, and greater severity of the symptoms may be negatively associated with physical and emotional functioning in survivorship. In exploratory analyses from a randomized controlled trial examining the effect of progressive resistance training on the development of lymphedema after BC, we aimed to examine the burden of the symptom cluster fatigue-pain-insomnia, and its prognostic value for long-term symptom severity as well as emotional and physical functioningMaterial and MethodsLatent profile analysis was used to identify groups with similar severity of pain, fatigue and insomnia among 158 patients with BC two weeks after surgery. Mixed effects Tobit regression models were used to estimate fatigue, pain, insomnia, and physical and emotional functioning 20 weeks, 1 year and 3.5 years after surgery.ResultsTwo symptom burden groups were identified: 80% of women had a low severity while 20% of women had a high severity of the three symptoms after BC surgery. 3.5 years later, the women with high symptom burden post-surgery still had higher pain, insomnia and fatigue scores than women with low symptom burden. High symptom burden post-surgery was associated with worse physical functioning 3.5 years later, while emotional functioning was only negatively impacted during the first year.DiscussionThese findings warrant larger studies investigating if symptom burden early in BC trajectory can be used for risk stratification for persistent symptoms and diminished physical functioning with the purpose of developing and implementing targeted interventions.

AB - BackgroundFatigue, insomnia and pain are some of the most common and distressing symptoms experienced during breast cancer (BC) treatment and survivorship. The symptoms have been found to impact one another and to form a symptom cluster, and greater severity of the symptoms may be negatively associated with physical and emotional functioning in survivorship. In exploratory analyses from a randomized controlled trial examining the effect of progressive resistance training on the development of lymphedema after BC, we aimed to examine the burden of the symptom cluster fatigue-pain-insomnia, and its prognostic value for long-term symptom severity as well as emotional and physical functioningMaterial and MethodsLatent profile analysis was used to identify groups with similar severity of pain, fatigue and insomnia among 158 patients with BC two weeks after surgery. Mixed effects Tobit regression models were used to estimate fatigue, pain, insomnia, and physical and emotional functioning 20 weeks, 1 year and 3.5 years after surgery.ResultsTwo symptom burden groups were identified: 80% of women had a low severity while 20% of women had a high severity of the three symptoms after BC surgery. 3.5 years later, the women with high symptom burden post-surgery still had higher pain, insomnia and fatigue scores than women with low symptom burden. High symptom burden post-surgery was associated with worse physical functioning 3.5 years later, while emotional functioning was only negatively impacted during the first year.DiscussionThese findings warrant larger studies investigating if symptom burden early in BC trajectory can be used for risk stratification for persistent symptoms and diminished physical functioning with the purpose of developing and implementing targeted interventions.

KW - Fatigue

KW - pain

KW - sleep initiation and maintenance disorders

KW - breast neoplasms

KW - survivorship

KW - quality of life

KW - risk assessment

KW - QUALITY-OF-LIFE

KW - EUROPEAN-ORGANIZATION

KW - ENDOCRINE THERAPY

KW - PAIN

KW - FATIGUE

KW - IMPACT

KW - PREVALENCE

KW - DEPRESSION

KW - SUBGROUPS

KW - WOMEN

U2 - 10.1080/0284186X.2023.2185909

DO - 10.1080/0284186X.2023.2185909

M3 - Journal article

C2 - 36912039

VL - 62

SP - 706

EP - 713

JO - Acta Oncologica

JF - Acta Oncologica

SN - 1100-1704

IS - 7

ER -