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

December 09, 2016

SAN ANTONIO - 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 breast cancer treatment," 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 breast cancer survivors 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, weight gain, 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 cancer survivors 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 symptoms 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 breast cancer 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."
Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania(founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $5.3 billion enterprise.

The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 18 years, according to U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $373 million awarded in the 2015 fiscal year.

The University of Pennsylvania Health System's patient care facilities include: The Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center -- which are recognized as one of the nation's top "Honor Roll" hospitals by U.S. News & World Report -- Chester County Hospital; Lancaster General Health; Penn Wissahickon Hospice; and Pennsylvania Hospital -- the nation's first hospital, founded in 1751. Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Chestnut Hill Hospital and Good Shepherd Penn Partners, a partnership between Good Shepherd Rehabilitation Network and Penn Medicine.

Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2015, Penn Medicine provided $253.3 million to benefit our community.

University of Pennsylvania School of Medicine

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