J Breast Cancer.  2018 Mar;21(1):37-44. 10.4048/jbc.2018.21.1.37.

Endocrine Treatment-Related Symptoms and Patient Outcomes in Breast Cancer: A Meta-Analysis

  • 1Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
  • 2Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea.
  • 3Department of Surgery, Seoul National University College of Medicine, Seoul, Korea. hanw@snu.ac.kr
  • 4Laboratory of Breast Cancer Biology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.


An association between endocrine treatment-related symptoms and breast cancer recurrence has been suggested previously; however, conflicting results have been reported. We performed a meta-analysis of published studies to clarify this relationship.
We systematically searched PubMed, Embase, Scopus, and the Cochrane database for studies investigating the association between endocrine treatment-related symptoms and patient survival. Random-effects meta-analysis was conducted with recurrence rate as the primary outcome.
Out of 7,713 retrieved articles, six studies were included. In patients who received endocrine treatment, the presence of any endocrine treatment-related symptom was found to be associated with a lower recurrence rate in comparison to an absence of any symptoms (hazard ratio [HR], 0.76; 95% confidence interval [CI], 0.66-0.87). This relationship persisted in patients presenting with only vasomotor or only musculoskeletal symptoms (HR, 0.74, 95% CI, 0.63-0.87; HR, 0.69, 95% CI, 0.55-0.86, respectively). At both time-points of symptom evaluation (3 months and 12 months), patients with endocrine treatment-related symptoms had a lower recurrence rate (HR, 0.74, 95% CI, 0.66-0.84; HR, 0.79, 95% CI, 0.69-0.90, respectively). This association was also significant in pooled studies including patients with and without baseline symptoms (HR, 0.73, 95% CI, 0.54-0.99; HR, 0.76, 95% CI, 0.69-0.85, respectively).
Endocrine treatment-related symptoms are significantly predictive of lower recurrence rate in breast cancer patients, regardless of the type of symptoms, time-point of evaluation, or inclusion of baseline symptoms. These symptoms could be biomarkers for the prediction of long-term responses to endocrine treatment in patients with breast cancer.


Breast neoplasms; Disease-free survival; Drug-related side effects and adverse reactions; Hormonal antineoplastic agent; Meta-analysis

MeSH Terms

Breast Neoplasms*
Disease-Free Survival
Drug-Related Side Effects and Adverse Reactions
Symptom Assessment
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