JNCI: Younger breast cancer survivors face quality of life issues

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Breast cancer patients aged 50 or younger experience psychosocial and menopause-related concerns, weight gain and infertility, according to a literature review published Jan. 20 in the Journal of the National Cancer Institute. The researchers called for additional studies and targeted interventions to address these symptoms and concerns.

Approximately 50,000 women aged 50 and younger in the U.S. are diagnosed with breast cancer each year. Survival rates for younger women with breast cancer have improved over the last two decades. Although many can expect long-term survival, they also contend with challenges, such as premature menopause, infertility, negative psychosocial effects and risk for recurrences and second episodes of primary breast cancer, according to Jessica Howard-Anderson, MS, medical student at University of California, Los Angeles, David Geffen School of Medicine, and colleagues.

“[Y]ounger breast cancer survivors are an important target population for interventions that focus on physical and psychological symptom relief, cancer prevention and risk reduction,” the authors wrote.

Howard-Anderson and colleagues conducted a literature review and identified 28 studies published between January 1990 and July 2010 that met inclusion criteria, including: exclusively analyzing female breast cancer survivors aged 50 years or younger or premenopausal at diagnosis and investigated quality of life- (QOL), menopause- or fertility-related concerns; and weight gain or physical activity-related behavioral health outcomes.

After extracting and analyzing the data, the researchers reached several conclusions. QOL in younger women with breast cancer was somewhat compromised, with mental functioning rather than physical functioning most severely affected. Many expressed anxiety over the future and fear of cancer recurrence. Depressive symptoms were common, particularly among women younger than age 35.

A range of 33 to 73 percent of women reported a menopausal transition with treatment, including consequences such as vasomotor symptoms and sexual problems. Women, particularly those who desired children, also experienced fertility concerns.

As far as behavioral outcomes, weight gain surfaced as a concern. Physical activity often diminished during treatment but increased after treatment completion.

Howard-Anderson et al referred to the link between weight gain and physical changes and psychological distress, and called for “a more comprehensive and integrative perspective.”

They wrote, “Management of psychological and menopausal symptoms is crucial for improving a woman’s general QOL, but, in addition, it is important to address these symptoms as ongoing psychological and hormonal problems may lead to poor adherence to adjuvant endocrine therapies in younger women.”

The researchers acknowledged several limitations to the study, including omission of other possibly important issues and a lack of systematic comparison with older women.

Finally, Howard-Anderson and colleagues called for “development and evaluation of interventions that target energy balance, fertility preservation, menopausal symptoms and management of depression and anxiety,” as well as studies that evaluate QOL interventions.