title: Impact of symptom burden on work-related abilities in patients with locally recurrent or metastatic breast cancer: Results from a substudy of the VIRGO observational cohort study.
abstract: Limited data exist on the association of symptom burden, daily activity impairment, and work productivity (WP) in patients with advanced breast cancer. This cross-sectional analysis evaluated baseline patient-reported outcomes (PROs) in patients with locally recurrent or metastatic breast cancer (MBC) receiving first-line hormonal therapy or chemotherapy and/or targeted therapy in the VIRGO observational study. The primary PRO study endpoint, symptom severity and interference score, was measured using the MD Anderson Symptom Inventory (MDASI). Secondary endpoints included Activity Level Scale (ALS), health-related quality of life (HRQOL), and Work Productivity and Activity Impairment Questionnaire (WPAI:SHP) scores. Overall, 152 patients (chemotherapy cohort, 104; hormonal therapy cohort, 48) answered questionnaires. Fatigue, decreased sexual interest, disturbed sleep, emotional distress, and drowsiness were the most common severe symptoms, and were of moderate-to-severe intensity in 38.8%-52.0% of patients. Mean percent daily activity impairment was 30% for study patients, and WP impairment ranged from 20% to 40% across indices in employed patients (n, 58). Significant positive correlations existed for MDASI severity and interference scores with activity impairment and WP indices (Pearson correlation coefficients [R] = 0.47-0.82; p < 0.0001). ALS and overall HRQOL correlated negatively with these indices (R = -0.41 to -0.60; p ≤ 0.001). After adjustment for potential confounders, MDASI symptom interference and ALS were significant predictors of activity and WP impairment. Our results indicate patients receiving treatment for MBC are symptomatic with significant daily activity and/or WP impairment. Symptom severity and interference, functional status, and overall HRQOL were moderately correlated with perceived work-related ability.
authors.affiliation: MD Anderson Cancer Center, Houston, TX, United States. Electronic address: ccleeland@mdanderson.org.
authors.forename: Charles S
authors.initials: CS
authors.lastname: Cleeland
authors.affiliation: AdvancedBC.org, New York, NY, United States.
authors.forename: Musa
authors.initials: M
authors.lastname: Mayer
authors.affiliation: Real-World & Late Phase Research, Quintiles, Cambridge, MA, United States.
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Dreyer
authors.affiliation: Genentech, Inc., South San Francisco, CA, United States.
authors.forename: Yeun Mi
authors.initials: YM
authors.lastname: Yim
authors.affiliation: Genentech, Inc., South San Francisco, CA, United States.
authors.forename: Elaine
authors.initials: E
authors.lastname: Yu
authors.affiliation: Real-World & Late Phase Research, Quintiles, Cambridge, MA, United States.
authors.forename: Zhaohui
authors.initials: Z
authors.lastname: Su
authors.affiliation: Genentech, Inc., South San Francisco, CA, United States.
authors.forename: Yong
authors.initials: Y
authors.lastname: Mun
authors.affiliation: Mayo Clinic Cancer Center, Rochester, MN, United States.
authors.forename: Jeff A
authors.initials: JA
authors.lastname: Sloan
authors.affiliation: Norris Cotton Cancer Center, Lebanon, NH, United States.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Kaufman
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D015331:Cohort Studies; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005221:Fatigue / Q000209:etiology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D063868:Patient Outcome Assessment; D011446:Prospective Studies; D012720:Severity of Illness Index; D012893:Sleep Wake Disorders / Q000209:etiology*; D013315:Stress, Psychological / Q000209:etiology*; D014937:Work
chemical_list: D000970:Antineoplastic Agents; D018931:Antineoplastic Agents, Hormonal
keywords: Breast neoplasms; Quality of life; Symptom assessment; Work