Untreated effects of breast cancer care increase depression and anxiety among survivors

December 9, 2016, Perelman School of Medicine at the University of Pennsylvania

Treatment advances have increased the five-year survival rate for breast cancer to 90 percent. 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 treatment. Long-term survivors report an average three symptoms for which they desire more help than they are receiving, according to 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. Results of the study will be presented on Friday at the 2016 San Antonio Breast Cancer Symposium (poster P5-13-12).

"There's almost an unwritten 'don't ask, don't tell' mentality about residual and persistent side effects of ," said lead author Steven Palmer, PhD, 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 who have been disease-free for at least three years completed surveys assessing the prevalence and severity of nineteen 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 percent of survivors reported at least three long-term symptoms, primarily fatigue, aching joints, , memory trouble, or insomnia, while 65 percent had at least one unmet need for intervention, with the average survivor reporting three unmet needs. 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 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 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, PhD, CRNP, director of Cancer Survivorship Programs at Penn's Abramson Cancer Center. "Our results point to a need for a more holistic view of 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."

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