October 2012 Edition Vol.11, Issue 10

Patient-Reported Outcomes Provide New Insights into Breast Cancer Survivors

Patient-Reported Outcomes Provide New Insights into Breast Cancer Survivors

By Kathy Annunziata, Vice President, Research Services, Kantar Health

Breast cancer is the most common form of cancer in women in the United States, and its mortality is second only to lung cancer in women and third to lung and colorectal cancers in the total U.S. population. The incidence of breast cancer in the United States has risen faster than mortality over the past decade due to a combination of factors: the general aging of the population, earlier detection, and advances in therapeutic options. The incidence of breast cancer is expected to continue to increase through at least 2025 as baby boomers age and their probability of developing the disease increases.

As the incidence of breast cancer increases, it can be useful to look at the demographics of breast cancer survivors: who they are, their state of health, and how they compare with the general population.

It is estimated that the incidence of breast cancer in the United States was approximately 294,000 in 2011, and 10-year survival has reached 66%.[1] According to data collected from patients in the 2011 National Health and Wellness Survey (NHWS), Kantar Health’s nationally representative, self-administered survey conducted annually via the Internet, over 80% of breast cancer survivors are older than 55 in the United States, with a mean age of 66 years.[2] On average they received their diagnosis more than 10 years ago, and 89% say they are now considered cancer-free. Despite this, 28% say they are still treating their breast cancer with a prescription medication.

Only 8% of breast cancer survivors report that they experienced symptoms related to cancer before speaking to their healthcare provider. More than half first discovered their breast cancer after having a mammogram, and another third first discovered their breast cancer through self-examination. Less than 10% first discovered their cancer through an examination by their healthcare provider.

When they ultimately received a diagnosis of breast cancer, one-third of survivors were diagnosed by their primary care provider or internist, one-fourth were diagnosed by an oncologist, and another 15% were diagnosed by their gynecologist.

Over half of breast cancer survivors who responded to the survey were diagnosed in the earliest stages of cancer. Twenty percent say they were diagnosed at stage 0, such as ductal carcinoma in situ, where the cancerous cells have not yet started to invade the surrounding tissue. According to CancerMPact, a large percentage of stage 0 patients receive no active therapy and are placed under watchful waiting. The most common treatment of patients in stage 0 is breast-conserving surgery accompanied by radiotherapy.[3]

One-third of breast cancer survivors say they were diagnosed at stage 1, where the cancerous cells are starting to invade the normal surrounding breast tissue. Breast-conserving surgery with radiotherapy is the treatment most commonly used with these patients. Survival among breast cancer patients decreases as their stage at diagnosis rises. Ten-year overall survival is 76% for stage 0 patients, 78% for stage 1, 68% for stage 2, 54% for stage 3A, 34% for stage 3B, and 9% for stage 4.  Only 1% of breast cancer survivors surveyed by NHWS say they were diagnosed at Stage 4.

Nearly 90% of breast cancer survivors underwent surgery to treat their cancer. A major trend in breast cancer surgery has been the use of less invasive procedures, with breast-conserving surgery or lumpectomy followed by radiation providing 10-year overall survival equivalent to mastectomy. According to NHWS, 57% of survivors say they received radiation therapy. External beam radiotherapy is used to kill any remaining tumor cells in the breast after breast-conserving surgery and is given to the chest wall after mastectomy when the probability of local recurrence is significant. Forty-one percent of survivors surveyed by NHWS say they have received chemotherapy, while 25% say they have received hormonal therapy.

Although nearly 90% of breast cancer survivors say they are cancer-free, one-quarter say they are still receiving chemotherapy or hormonal therapy to treat their breast cancer. Patients typically receive adjuvant hormone therapy following surgery for early-stage disease, and the recommended treatment is five years of hormone therapy. While these patients are technically cancer-free, the adjuvant therapy is designed to kill off any microscopic disease that may exist but not be detectable.  These patients are monitored periodically by their oncologists, with appointments every six to 12 months. Forty percent of breast cancer survivors surveyed by NHWS have had at least one appointment with their oncologist in the past six months.

A strong family history of cancer, particularly premenopausal breast and/or ovarian cancer in first-degree relatives can indicate a genetic predisposition to breast cancer. Indeed, more than one-third of breast cancer survivors responding to the NHWS say they have a family history of breast cancer.

Breast cancer appears to take a large toll on survivors’ physical health. As measured by the SF-12v2, a series of 12 validated questions that are scored to provide an index of respondents’ mental health, physical health and overall quality of life, breast cancer survivors have poorer physical health compared with the general U.S. population: 42.8 vs 48.6. However, survivors’ mental health is better than the general population at 50.4 vs 48.2.

In general breast cancer survivors seem to have better relationships with their physicians and are more trusting of their physicians than the general U.S. population. Over three-quarters of breast cancer survivors feel that their doctor is very attentive to their needs and concerns, compared with 59% of the U.S. population. Two-thirds believe that having regular contact with their physician is the best way to avoid illness, versus 46% in the general population. They also keep their physicians apprised of medication use, with 85% saying their doctor knows about all of the over-the-counter products they use, compared with 61% in the general population.

Survivors also appear to be more compliant when taking their medications compared with the general U.S. population. Eight in 10 breast cancer survivors say that unless there is a good reason to change their medication it’s best to keep taking it as they currently do; in contrast, six in 10 Americans in the general population feel the same. Breast cancer survivors also are more likely to take their medication at the same time every day: 86% vs 67% of the total U.S. population. They are far more likely to take the entire course of their medication even when they feel better, with only 10% of survivors saying they stop taking their medication when they feel better, compared with 24% of the population as a whole.

More breast cancer survivors take a multivitamin every day to improve or maintain their health (68% compared with 53% of the general population). They are also much more willing to take a prescription medication every day for the rest of their life to prevent a disease they may be at risk of having in the future (61% vs 46% in the general population). However, fewer breast cancer survivors believe their own behavior determines how soon they get well when they are sick.

Breast cancer survivors are more likely to be overweight (70% vs 66% in the general population). However, fewer of them smoke (14% vs 18%) and drink alcohol (55% vs 63%) than Americans in general.

Key Points

By looking at their outcomes and attitudes, we found that the majority of breast cancer survivors tend to be more active regarding their health and are more trusting of their doctors compared with the general population. Breast cancer survivors are taking steps to prevent various health conditions, especially osteoporosis. Many take a vitamin every day to maintain their health, and despite being older than the general population breast cancer survivors are exercising regularly as another preventive measure.

Although a number of risk factors have been identified, most women who get breast cancer have no obvious risk factors for the disease other than age. Genetic screening and counseling are becoming increasingly important tools for the early identification and treatment of those “at risk” for the disease.



[1] Kantar Health, CancerMPact Patient Metrics, accessed October 18, 2012.                                                                          

[2] Kantar Health, National Health and Wellness Survey, 2011 [US]. Princeton, NJ.

[3] Kantar Health, CancerMPact Treatment Architecture, accessed October 18, 2012.

 

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