Low-risk breast cancer survivors' expectations for symptom discussions during oncology follow-up.

Abstract

470 Background: Over 2 million low-risk breast cancer survivors need follow-up, addressing multiple symptom and well-being domains within time-limited oncology/survivorship visits. Although integrating PRO assessments into routine care facilitates symptom reporting, failure to discuss them in follow-up contributes to undermanaged patient-driven concerns. We assessed survivors' expectations for discussing symptoms with their oncology/survivorship team. Methods: We analyzed randomized controlled trial data from survivors of stage I, ER/PR-positive/HER2-negative breast cancer, 6–36 months post-diagnosis with no chemotherapy. Two weeks before oncology visits, survivors completed a PRO symptom survey, co-developed with stakeholders and based on ASCO survivorship guidelines, assessing symptoms related to distant/local recurrence, endocrine therapy, breast/chest wall discomfort, lymphedema, body image, sexual health, and mental health. Post-visit, survivors reported whether they expected to discuss symptoms with their team. Expectations did not differ by arm; arms were combined and summarized descriptively. Results: 99 survivors completed 216 pre-visit PRO surveys. Participants were a median 63 years (range 36–86), 12.5 months post-diagnosis, and 51.9% of assessments had 1+ threshold-level symptoms. The most reported symptoms were endocrine therapy and breast/chest wall discomfort (Table). Expectations to discuss symptoms were highest for breast concerns (100%), breast/chest wall discomfort (78.9%), endocrine therapy (70.9%), sexual health (70%), and distant recurrence (57.9%), and lower for lymphedema (50%), mental health (31.3%; 20% anxiety, 50% depression), and body image (22.2%). Conclusions: In this low-risk cohort, a meaningful proportion reported threshold-level symptoms. Although assessed symptoms represent ASCO survivorship domains, more survivors expected to discuss physical/medical than psychosocial symptoms, suggesting patients may not expect psychosocial concerns addressed in time-limited oncology visits. Future work should help oncology providers address patients' priority symptoms across all domains. Clinical trial information: NCT05047575 . Domain Patients with Symptoms (N=99) n (%) Assessments with Symptoms (N=216) n (%) Symptoms Patients Expected to Discuss n/N* (%) Distant Recurrence 20 (20.2) 27 (12.5) 22/38 (57.9) Endocrine Therapy Symptoms 36 (36.4) 50 (23.1) 32/48 (66.7) Endocrine Therapy-Missed Dose 7 (7.1) 7 (3.2) 7/7 (100) Breast Concerns 6 (6.1) 8 (3.7) 8/8 (100) Body Image Concerns 9 (9.1) 11 (5.1) 2/9 (22.2) Breast/Chest Wall Discomfort 30 (30.3) 42 (19.4) 30/38 (78.9) Lymphedema Symptoms 15 (15.2) 24 (11.1) 10/20 (50) Sexual Health 19 (19.2) 22 (10.2) 14/20 (70) Mental Health 13 (13.1) 19 (8.8) 5/16 (31.3) *Threshold-level symptoms with matching post-visit survey. Total N can exceed (multiple symptoms per domain) or fall below (post-visit non-response) column 3.