Symptom trajectories in breast cancer survivors: growth mixture analysis of patient-reported pain, fatigue, insomnia, breast and arm symptoms

Nielsen, Anders Winther Mølby; Lundorff, Marie; Nielsen, Hanne Melgaard; Alsner, Jan; Vrou Offersen, Birgitte; Kristensen, Morten Horsholt; Zachariae, Robert

doi:10.1080/0284186x.2021.1981550

Cited by 22Cancer survivorship and careChildhood Cancer Survivors' Quality of LifeCancer-related cognitive impairment studies

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Symptom trajectories in breast cancer survivors: growth mixture analysis of patient-reported pain, fatigue, insomnia, breast and arm symptoms

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Nielsen, Anders Winther Mølby, Lundorff, Marie, Nielsen, Hanne Melgaard, Alsner, Jan, Vrou Offersen, Birgitte, Kristensen, Morten Horsholt, Zachariae, Robert·2021·Acta Oncologica

DOI 10.1080/0284186x.2021.1981550

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Abstract

Background Variations in symptom development among breast cancer (BC) survivors are understudied. We examined: (Q1) Symptom trajectories of pain, fatigue, insomnia, breast, and arm symptoms in BC survivors, (Q2) possible patterns or cluster-like associations between trajectory classification of different symptoms, and (Q3) characteristics of survivors assigned to high-burden symptom trajectories.Material and methods Participants were 968 women (mean age = 59.6 years) treated for early-stage BC and followed across a three-year postoperative period. As part of routine follow-up procedures, patients reported symptom burden and functioning levels at each hospital visit using the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30) and the BC-specific module (QLQ-BR-23). Growth mixture modeling (GMM) analysis was used to differentiate potential subgroups of individuals with similar longitudinal symptom patterns, i.e., symptom trajectories (Q1). With this approach, groups experiencing persistent, highly distressing cancer- and treatment-related late effects (LEs) may be identified. Latent class analysis (LCA) was used for Q2 and logistic regression analysis for Q3.Results GMM identified two relatively parallel trajectories across the tested symptoms: The majority of the sample exhibited a low-burden symptom trajectory (74.4–89.2%) and a minority by a high-burden symptom trajectory (10.8–25.6%). LCA revealed that approximately one in five women (18.8%) were likely to be members of the high-burden symptom trajectory across all tested symptoms. In addition to a high probability of being burdened over time across multiple symptoms, these women were also characterized by poorer self-reported physical and social functioning.Conclusion A substantial minority followed a high-burden symptom trajectory for several years following BC treatment. Associations were found in trajectory classification across symptoms, indicating that cancer-related LEs appear in clusters of multiple concurrent symptoms.

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These symptom clusters tend to persist, significantly burdening patients and survivors.
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Authors: Nielsen, A. W. M., Lundorff, M., Nielsen, H. M., Alsner, J., Vrou Offersen, B., Kristensen, M. H., & Zachariae, R.
Affiliations: Aarhus University Hospital (DK)
Aarhus University (DK)
Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
Corresponding author: Nielsen, Anders Winther Mølby
ORCID: Nielsen, Anders Winther Mølby
Lundorff, Marie
Alsner, Jan
Kristensen, Morten Horsholt
Zachariae, Robert
Venue: Acta Oncologica
Publisher: MJS Publishing, Medical Journals Sweden AB
Published: 2021-09-28
Volume: 60
Issue: 12
Pages: 1659-1667
ISSN: 0284-186X (ISSN-L)
1651-226X
DOI: 10.1080/0284186x.2021.1981550
OpenAlex: W3204499203
Cited by: 22
References: 54
Citations by year: 2026: 4 · 2025: 6 · 2024: 6 · 2023: 3 · 2022: 2 · 2021: 1
FWCI: 1.09
Type: journal article
Language: en
Open access: diamond
doi.org
Locations: Acta Oncologica (publishedVersion)
PubMed (publishedVersion)
Funders: Danish Breast Cancer Group Center and Clinic for Late Effects
Topics: Health Sciences › Medicine › Oncology › Cancer survivorship and care
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Childhood Cancer Survivors' Quality of Life
Health Sciences › Medicine › Oncology › Cancer-related cognitive impairment studies
Keywords: breast cancer survivors, symptom trajectories, late effects of cancer treatment, cancer pain, cancer-related fatigue, insomnia, breast symptoms, arm symptoms, symptom burden, physical function, social functioning, EORTC QLQ-BR23, EORTC QLQ-C30
MeSH terms: Patient Reported Outcome Measures, Cancer Survivors, Arm, Breast Neoplasms, Fatigue, Female, Humans, Sleep Initiation and Maintenance Disorders, Middle Aged, Pain, Quality of Life, Survivors

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Symptom trajectories in breast cancer survivors: growth mixture analysis of patient-reported pain, fatigue, insomnia, breast and arm symptoms

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