Physical symptoms a priority in advanced breast cancer
By Sarah Guy, medwireNews Reporter
28 March 2013
Eur J Cancer Care 2013; 22: 272–280

medwireNews: Women with advanced breast cancer adapt to their emotional and spiritual symptoms despite reporting poor physical functioning and pain compared with women who have local or regional disease, indicate US study results.

Specifically, patients with metastatic disease had fewer depressive symptoms and less nausea, but more pain and a lower functional status, write the researchers in the European Journal of Cancer Care.

The findings stress the importance of prioritizing the management of physical symptoms in this population, they add.

"When a decision to include those with or without distant metastasis or both in a supportive care study is being made, it is important to understand the differences between these groups to formulate appropriate inclusion or exclusion criteria," say Glen Wyatt (Michigan State University, East Lansing) and colleagues.

The team analyzed data from a group of 385 women with breast cancer who took part in a reflexology versus lay foot manipulation/conventional care trial. The women reported their metastatic status, the type of treatment they were receiving, and their comorbid conditions using measures such as the physical functioning subscale of the medical outcomes study short form-36, the brief pain inventory short form, and the state anxiety scale.

Overall, those with distant metastasis (n=298) were significantly older than women with local or regional disease (n=87), at 57 versus 52 years, and had significantly fewer comorbid conditions, at 0.7 versus 1.1.

After adjusting for age, comorbidity, type of treatment (chemotherapy or hormone therapy), and time since cancer diagnosis, women with metastatic disease had significantly poorer physical functioning and more pain compared with those who had local or regional disease.

Specifically, mean physical function scores out of 100 - where a higher score represents more functionality - were 55.9 versus 65.5 for women with distant metastasis versus those with local or regional disease, and corresponding pain scores were 3.8 versus 0.3 (out of 10, where higher scores denote greater pain).

By contrast, the research team observed no significant differences in levels of fatigue, nausea, shortness of breath, sleep quality, anxiety, depressive symptoms, or spirituality.

"The lower physical functioning may be a result of the continuous symptom of pain over time," suggest Wyatt and co-workers.

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