Breast cancer survivorship continues to rise, but the long-lasting psychosocial and quality-of-life changes that occur after treatment need to be studied, as treatment outcomes can lead to negative side effects that outlast the treatment.
Younger women treated for cancer have unique concerns—premature menopause, infertility, and negative psychosocial effects. Understanding treatment outcomes and the health-related quality of life as patients decide on a treatment path and undergo medical care is important for evaluating the qualitative outcomes of cancer treatments. Younger breast cancer survivors especially need to consider infertility and risk of recurrence and to focus on the relief of both physical and psychological symptoms.
A study published in the Journal of the National Cancer Institute has assessed these qualitative outcomes among 28 studies published over the last 10 years. The results showed that younger women with breast cancer have a decreased quality of life that is linked to psychological distress, weight gain, and a lack of physical activity. Additionally, treatment was linked to infertility and early onset menopause.
"We did a review of the literature and focused only on studies that examined women less than 51 years or those who were premenopausal. We were interested in the unique issues facing younger women with breast cancer," explained lead author Patricia A. Ganz, MD. Ganz is the director of cancer prevention and control research at the Jonsson Comprehensive Cancer Center at the University of California Los Angeles.
Depression symptoms were more severe and more frequent among younger breast cancer survivors when compared to survivors older than 50 or to women without cancer. These mood disorders were particularly prominent among women 35 years old or younger. Unsurprisingly, the younger women were more concerned with early menopause and infertility due to treatment.
Ganz and colleagues suggest that this cohort of breast cancer patients should receive comprehensive guidance during treatment especially because the results suggest that anxiety and depression influences the level of exercise and weight gain that occurs. Weight gain appears to be treatment-specific, as the younger women did not report an increase in calorie intake during treatment. The relationships among these factors are complex because weight gain, infertility, and early menopause, which are biological responses to treatment, also lead to a negative mental state and depression.
"We are recommending that physicians prepare younger breast cancer patients for these problems—infertility, menopause, weight gain—and help them with the increased anxiety and distress that they experience as well as menopausal symptoms. These are often neglected in the post-treatment period," Ganz said.
The preservation of fertility for patients is still a work in progress. While there are guidelines from American Society of Clinical Oncology (ASCO) available since 2006, the researchers highlight that advanced techniques may only be available at a limited number of medical centers and are still evolving.
Since breast cancer treatment has become tailored to the particular subtype of breast tumor, the next step would be to analyze these qualitative outcomes based on specific breast cancer treatments. The study "raises more questions than it answers," according to the authors. What we really need is specific information on these qualitative measures based on specific treatments of distinct types of breast cancers.
The researchers state that personalized treatment for breast cancer in younger women is particularly important. "By tailoring adjuvant therapy regimens and giving cytotoxic therapy only to those who may benefit, we can mitigate some of these side effects, but the long life expectancy for these younger women also provides a window of opportunity for cancer prevention and health promotion activities."
Ganz and her colleagues will continue to focus on improving the outcomes for younger women with breast cancer. She is involved in clinical trials that have an outcomes assessment component, looking at the risk for menopause and weight gain among women that are treated with the newer generation adjuvant chemotherapies. As a follow-up on the current study, Ganz is part of a randomized trial that is testing the effects of meditation on lowering stress levels in younger breast cancer patients.
