Background: Bone is the most common site of distant metastasis in advanced breast cancer patients (pts). Development of bone metastases (mets) is associated with substantial morbidity including skeletal complications, decreased quality of life, increased pain, and shortened lifespan. Pt burden of symptoms associated with bone mets has been assessed in tumor types other than breast or in metastatic disease not specific to bone. This study characterizes patterns of pt-reported symptoms over time among breast cancer pts with bone mets.

Methods: The Oncology Services Comprehensive Electronic Records (OSCER) database was used to retrospectively identify women with breast cancer who developed bone mets during their care and had ≥1 ACORN Patient Care Monitor (PCM) assessment. The PCM summarizes symptoms on an 11-point scale (0 = not a problem to 10 = as bad as possible). Moderate/severe symptoms were defined by a PCM score ≥4. PCM items relevant to metastatic disease (fatigue, physical pain, trouble sleeping, numbness/tingling, anxious, loss of interest in others) were assessed. A generalized linear mixed model was used to evaluate symptom progression before and after bone mets diagnosis (dx). Kaplan-Meier methods were used to estimate time to development of and proportion of pts with moderate/severe symptoms after bone mets dx.

Results: 1105 pts with breast cancer and bone mets were included. In general, the proportion of pts with moderate/severe symptom burden increased in the months (mos) before bone mets dx (Table 1). The odds (risk) of pts experiencing moderate/severe symptom burden increased in the mos leading up to bone mets dx, with a 9% increase per mo for both fatigue and physical pain, and a 19% increase per mo for numbness/tingling (P<0.001 for all). Non-significant changes were observed in the risk of pts experiencing trouble sleeping (3%), anxiousness (0%), or loss of interest in others (16%). After bone mets dx, the cumulative proportion of pts with moderate/severe symptom burden increased with time (Table 2). Median time to moderate/severe symptoms after bone mets dx was 1.4 mos for fatigue, 1.9 mos for physical pain, 3.9 mos for trouble sleeping, 9.3 mos for numbness/tingling, 20.6 mos for anxious, and was not reached for loss of interest in others.

Table 1. Unadjusted proportion of pts with moderate/severe symptom burden before or at time of bone mets dx

Symptom 12 mos before dx 6 mos before dx At bone mets dx 
Fatigue 35% 37% 52% 
Physical pain 29% 34% 47% 
Trouble sleeping 22% 25% 28% 
Numbness/tingling 16% 18% 19% 
Anxious 14% 16% 23% 
Loss of interest in others 4% 6% 6% 
Symptom 12 mos before dx 6 mos before dx At bone mets dx 
Fatigue 35% 37% 52% 
Physical pain 29% 34% 47% 
Trouble sleeping 22% 25% 28% 
Numbness/tingling 16% 18% 19% 
Anxious 14% 16% 23% 
Loss of interest in others 4% 6% 6% 

Conclusions: These data from a large number of breast cancer pts treated at community oncology practices show that pts experience increasing symptom burden for a substantial period of time before bone mets dx. Most pts continue to experience burdensome symptoms after bone mets dx. These findings reinforce the need for multiple symptoms to be proactively monitored and managed in these pts.

Table 2. KM estimate: cumulative proportion of pts with moderate/severe symptom burden after bone mets dx

Symptom 2 mos after dx 12 mos after dx 
Fatigue 58% 82% 
Physical pain 51% 74% 
Trouble sleeping 39% 64% 
Numbness/tingling 26% 53% 
Anxious 27% 46% 
Loss of interest in others 9% 22% 
Symptom 2 mos after dx 12 mos after dx 
Fatigue 58% 82% 
Physical pain 51% 74% 
Trouble sleeping 39% 64% 
Numbness/tingling 26% 53% 
Anxious 27% 46% 
Loss of interest in others 9% 22% 

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-10-01.