Low-Risk Breast Cancer Survivors May Experience Long-Term Physical and Psychological Effects

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Survivors of low-risk breast cancer may experience wide-ranging and significant physical and psychological symptoms after cancer treatment, according to a new study presented by Jessica Schumacher, PhD, and colleagues at the American Society of Breast Surgeons (ASBrS) Annual Meeting. Researchers found that hot flashes, fatigue, back and joint pain, and anxiety were among the most commonly cited issues via a self-reported assessment (Abstract 238).

Lead study author Dr. Schumacher, of the University of Wisconsin-Madison, noted that little research has focused on the posttreatment concerns of low-risk breast cancer survivors, and that this new study demonstrates that survivorship is rarely easy—regardless of the patient’s care path and recurrence risk.

“This study suggests early-stage survivors experience a high burden of symptoms and concerns that have important implications for their quality of life after cancer treatment,” she noted. “It also suggests that a previsit self-assessment tool measuring symptoms and concerns may be helpful in identifying concerns that may not otherwise be recognized, given that follow-up physician visits are often subject to time limitations that make in-depth discussion of a full range of issues difficult.”

Physicians should be aware that breast cancer survivorship comes with a significant ongoing burden of symptoms, even for those who experience a mild form of the disease and do not receive aggressive treatment.
— Jessica Schumacher, PhD

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Study Details

The study examined responses from 98 women at a single institution with an average age of 61.3 years. Participants had a history of low-risk stage I and II, estrogen/progesterone-positive, HER2-negative cancers. They ranged from 6 months to 5 years post–breast cancer diagnosis, with an average of 2.6 years. Of these women, 71.3% had undergone lumpectomies, while 28.7% had been treated with mastectomy. None received chemotherapy.

Survey topics were shaped in part by ASCO and American Cancer Society survivorship assessment guidelines. Respondents indicated the extent of their concerns on each issue based on several measurements. Clinical significance was determined through a variety of measurement tools as well as established thresholds for symptoms if relevant.

Survey Results

Common symptoms and concerns also included endocrine therapy, headaches, bone pain, arm swelling, and new breast symptoms potentially indicative of a recurrence.

The most frequently cited issues (≥ 20% of survey respondents) were hot flashes, fatigue, back pain, joint pain, anxiety, problem taking endocrine therapy (missed doses or could not take), and headache.

Overall, 86.7% of patients reported clinically significant concerns, including 38.8% with one or two and 47.9% with three or more issues.

“Physicians should be aware that breast cancer survivorship comes with a significant ongoing burden of symptoms, even for those who experience a mild form of the disease and do not receive aggressive treatment,” said Dr. Schumacher. “Our experience in developing this study suggests that a self-reported, preappointment assessment tool such as the one used here may be useful in helping physicians appropriately address patient concerns. It may alert them to symptoms with potential health implications and help physician visits focus on symptoms that are important to patients, providing a stimulus for meaningful discussions.”

Dr. Schumacher noted that her own institution is exploring ways to incorporate a similar tool in their breast cancer follow-up protocols.

Disclosure: For full disclosures of the study authors, visit

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.