Patient-reported symptoms before adjuvant locoregional radiotherapy for breast cancer: triple-negative histology impacts the symptom burden.

Abstract

Multimodal breast cancer treatment may cause side effects reflected in patient-reported outcomes and/or symptom scores at the time of treatment planning for adjuvant radiotherapy. In our department, all patients have been assessed with the Edmonton Symptom Assessment System (ESAS; aquestionnaire addressing 11major symptoms and wellbeing on anumeric scale of 0-10) at the time of treatment planning since 2016. In this study, we analyzed ESAS symptom severity before locoregional radiotherapy. Retrospective review of 132 patients treated between 2016 and 2021 (all comers in breast-conserving or post-mastectomy settings, different radiotherapy fractionations) was performed. All ESAS items and the ESAS point sum were analyzed to identify subgroups with higher symptom burden and thus need for additional care measures. The biggest patient-reported issues were fatigue, pain, and sleep problems. Patients with triple negative breast cancer reported ahigher symptom burden (mean 30 versus20, p = 0.038). Patients assigned to adjuvant endocrine therapy had the lowest point sum (mean18), followed by those on Her-2-targeting agents without chemotherapy (mean19), those on chemotherapy with or without other drugs (mean26), and those without systemic therapy (mean41), p = 0.007. Those with pathologic complete response after neoadjuvant treatment had significantly lower anxiety scores (mean 0.7 versus1.8, p = 0.03) and atrend towards lower depression scores, p = 0.09. Different surgical strategies, age, and body mass index did not impact on ESAS scores, while the type of adjuvant systemic therapy did. The effect of previous neoadjuvant treatment and unfavorable tumor biology (triple negative) emerged as important factors associated with symptom burden, albeit in different domains. ESAS data may facilitate identification of patients who should be considered for additional supportive measures to alleviate specific symptoms.