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

• Yoo TK
• Jang MJ
• Lee E
• Moon HG
• Noh DY
• Han W

• KMID: 2441866
• DOI: http://doi.org/10.4048/jbc.2018.21.1.37

Abstract

PURPOSE
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.
METHODS
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.
RESULTS
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).
CONCLUSION
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.

Keyword

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

MeSH Terms

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

Figure

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  Figure 1 Study selection process.

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  Figure 2 Meta-analysis of endocrine treatment-related symptoms and recurrence rate.HR=hazard ratio; CI=confidence interval.

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  Figure 3 Meta-analysis of endocrine treatment-related symptoms and recurrence-free survival according to type of symptom, time point of symptom evaluation and inclusion of patients with baseline symptoms. Forest plot for patients with only vasomotor symptoms (A) and patients with only musculoskeletal symptoms (B). Forest plot according to evaluation time point by specific time point of 3 months (C) and 12 months (D) after start of treatment. (E) Meta-analysis result when including patients with baseline symptoms. (F) Forest plot of only including patients with no baseline symptoms.HR=hazard ratio; CI=confidence interval.

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