Endocrine Abstracts

Background: Through the decades, aromatase inhibitor maintenance therapy for patients with postmenopausal non-metastatic estrogen receptor-positive breast cancer has improved significantly. This study focuses on the patient’s further breast cancer course and clarifies the extensive symptom burden that the endocrinologist should be aware of.

Aim: The study aims to gain insight into a potential gap between the endocrine symptoms outlined in guidelines versus the symptoms that the clinicians register in the medical records after the patients have expressed the symptoms at the consultations and in semi-structured interviews.

Methods: A Mixed-Method study. Symptoms were classified according to the National Cancer Institute (NIH) and clustered according to the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life C30 (QLQ-C30) questionnaire (EORTC QLQ C30) and new domains (menopausal, body alteration, gastrointestinal, eye-, skin-, mouth- and sex-related). Patients with early breast cancer in follow-up treated with aromatase inhibitors (letrozole, exemestane or anastrozole) were included. Symptom registration was compared with the European Medicines Agency (EMA), the Food and Drug Administration (FDA), international and national guidelines for the standard evidence-based clinical practice: oncological (American Society of Clinical Oncology (ASCO), European Society for Medical Oncology (ESMO), Danish Breast Cancer Group (DBCG) and Danish Multidisciplinary Cancer Group (DMCG)) and endocrine societies (Endocrine Society, European Society of Endocrinology (ESE) and Danish Endocrine Society (DES)).

Results: Patients for the medical record audit were included over a recruitment period of 3 months (n=23). Single symptoms were identified by the NIH definition (n=235). Patients included in the semi-structured interviews (n=19). Single symptoms were identified by the NIH definition (n=321). Several symptoms identified in the medical records and interviews were also registered in the guidelines but described with different frequencies e.g., dry mouth. The breast cancer population and their symptoms were, however, not mentioned at all in best-practice endocrine guidelines and very few in some of the best-practice oncology guidelines.

Conclusion: Our results indicate that symptoms either are not outlined in the best practice guidelines or do not embrace the total patient-experienced symptoms as outlined by the physicians and patients with breast cancer. There seems to be a discrepancy between the frequency of various symptoms. Four domains: role functioning, social functioning, Global Health status/QOL, and sex-related symptoms found in medical record audits and patient interviews were exclusively absent from the guidelines. There is a need to implement the most frequent symptoms in national as well as international guidelines.