Patient-reported symptoms after breast cancer diagnosis and treatment: A retrospective cohort study

AIM: Breast cancer and its treatment are associated with varying symptoms. The province of Ontario (13.6 million) has implemented a provincial programme to screen for symptoms among cancer patients using the Edmonton Symptom Assessment System (ESAS). The purpose of this study was to describe symptom burden in the year after diagnosis among women with breast cancer. METHODS: This observational study linked cancer incidence, stage, treatment and demographic data with ESAS scores collected at cancer clinic visits. The cohort consisted of all adult women diagnosed with stage I-III breast cancer between 2007 and 2013 who received surgery as their primary treatment and had at least one symptom screening record. The prevalence and trajectory of moderate-to-severe and severe symptom scores in the year after diagnosis were described. Multivariable logistic regression models identified factors associated with moderate-to-severe and severe symptom scores. RESULTS: The cohort included 23,840 breast cancer patients and with 90,556 unique symptom assessments, within the first year from diagnosis. Tiredness had the highest incidence of moderate-to-severe scores; 60% reported at least one moderate-to-severe score in the 12 months after diagnosis, followed by impaired well-being (53%) and anxiety (44%). Elevated symptom scores were most commonly reported in 6 months after diagnosis. Higher comorbidity score (Aggregated Diagnosis Group ≥10), more advanced stage at diagnosis, younger age, urban residence, lower income and treatment course were associated with moderate-to-severe and severe symptom scores. CONCLUSION: These findings identify time points and patient subgroups at risk for elevated symptom scores and may benefit from personalised or targeted supportive care interventions.