title: Treatment-associated toxicities reported by patients with early-stage invasive breast cancer.
abstract: Patient-reported toxicities help to appraise the breast cancer treatment experience. Yet extant data come from clinical trials and health care claims, which may be biased. Using patient surveys, the authors sought to quantify the frequency, severity, and burden of treatment-associated toxicities.
  
  
  
  Between 2013 and 2014, the iCanCare study surveyed a population-based sample of women residing in Los Angeles County and Georgia with early-stage, invasive breast cancer. The authors assessed the frequency and severity of toxicities; correlated toxicity severity with unscheduled health care use (clinic visits, emergency department visits/hospitalizations) and physical health; and examined patient, tumor, and treatment factors associated with reporting increased toxicity severity.
  
  
  
  The overall survey response rate was 71%. From the analyzed cohort of 1945 women, 866 (45%) reported at least 1 toxicity that was severe/very severe, 9% reported unscheduled clinic visits for toxicity management, and 5% visited an emergency department or hospital. Factors associated with reporting higher toxicity severity included receipt of chemotherapy (odds ratio [OR], 2.2; 95% confidence interval [95% CI], 2.0-2.5), receipt of both chemotherapy and radiotherapy (OR, 1.3; 95% CI, 1.0-1.7), and Latina ethnicity (OR vs whites: 1.3; 95% CI, 1.1-1.5). A nonsignificant increase in at least 1 severe/very severe toxicity report was observed for bilateral mastectomy recipients (OR, 1.2; 95% CI, 1.0-1.4).
  
  
  
  Women with early-stage invasive breast cancer report substantial treatment-associated toxicities and related burden. Clinicians should collect toxicity data routinely and offer early intervention. Toxicity differences observed by treatment modality may inform decision making. Cancer 2017;123:1925-1934. © 2017 American Cancer Society.
authors.affiliation: Department of Systems, Populations, and Leadership, School of Nursing, and Institute for Healthcare Policy and Innovation, University of Michigan.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Friese
authors.affiliation: Department of Systems, Populations, and Leadership, School of Nursing, and Institute for Healthcare Policy and Innovation, University of Michigan.
authors.forename: Jordan M
authors.initials: JM
authors.lastname: Harrison
authors.affiliation: Department of Health Behavior and Health Education, School of Public Health, University of Michigan.
authors.forename: Nancy K
authors.initials: NK
authors.lastname: Janz
authors.affiliation: Department of Radiation Oncology, University of Michigan School of Medicine.
authors.forename: Reshma
authors.initials: R
authors.lastname: Jagsi
authors.affiliation: Memorial Sloan-Kettering Cancer Center.
authors.forename: Monica
authors.initials: M
authors.lastname: Morrow
authors.affiliation: Department of Biostatistics, University of Michigan School of Public Health.
authors.forename: Yun
authors.initials: Y
authors.lastname: Li
authors.affiliation: University of Southern California Keck School of Medicine.
authors.forename: Ann S
authors.initials: AS
authors.lastname: Hamilton
authors.affiliation: Rollins School of Public Health, Emory University.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Ward
authors.affiliation: Departments of Medicine and Health Research and Policy, Stanford University Medical Center.
authors.forename: Allison W
authors.initials: AW
authors.lastname: Kurian
authors.affiliation: Departments of Internal Medicine and Health Management and Policy, Schools of Medicine and Public Health, University of Michigan.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Katz
authors.affiliation: Veterans Affairs Center for Clinical Management Research, Health Services Research and Development Service Center of Innovation and Department of Internal Medicine, University of Michigan.
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Hofer
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000473:pathology / Q000628:therapy*; D000072716:Cancer Pain / Q000209:etiology; D002277:Carcinoma / Q000473:pathology / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant; D017024:Chemotherapy, Adjuvant; D003248:Constipation / Q000209:etiology; D003967:Diarrhea / Q000209:etiology; D004417:Dyspnea / Q000209:etiology; D004487:Edema / Q000209:etiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008408:Mastectomy / Q000009:adverse effects*; D015412:Mastectomy, Segmental / Q000009:adverse effects; D008875:Middle Aged; D009325:Nausea / Q000209:etiology; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology; D011855:Radiodermatitis / Q000209:etiology; D011878:Radiotherapy / Q000009:adverse effects*; D018714:Radiotherapy, Adjuvant; D012720:Severity of Illness Index; D014839:Vomiting / Q000209:etiology
chemical_list: D000970:Antineoplastic Agents
keywords: breast cancer; patient report; treatment experience; treatment-associated toxicities