Patient-reported distress and correlates while on adjuvant endocrine therapy following breast cancer treatment among post-menopausal women: a group-based trajectory model analysis

PURPOSE: To examine changes in patient-reported distress in female breast cancer (hormone-receptor-positive, stages 1-3) patients aged 55 + taking adjuvant endocrine therapy (AET). METHODS: A retrospective cohort was constructed using the electronic health record (EHR) at a single Midwestern site from 2014 to 2019. Patients (N = 390) were included if they had completed two or more distress thermometer (DT) assessments. The DT is scored from 0 to 10; four is the threshold for clinically concerning distress. Trajectories were assigned using group-based trajectory modeling analyses. Predictors of group membership were identified using a cross-validated lasso algorithm. RESULTS: The best-fit model included four groups. Group 1 (22%) had no distress, Group 2 (29%) had low distress (average DT = 0.8) that remained low, Group 3 (33%) had medium-low distress (2.7) that remained low, and Group 4 (16%) had high distress (6.2) that decreased but remained high (5) over time. Higher initial DT value was associated with a decreased odds of membership in Group 1 (OR = 0.88; 95% CI (0.80-0.95)) and increased in Group 4 (OR = 1.14; 95% CI (1.06-1.25)). Endorsement of sleep issues was associated with decreased odds of membership in Group 1 (OR = 0.59; 95% CI (0.40-0.87)) and increased odds of membership in Group 3 (OR = 1.53; 95% CI (1.11-2.26)). CONCLUSION: The majority of post-menopausal women do not report distress while taking AET; however, one in six reports high distress that did not dissipate with time. This work adds to the understanding of distress in breast cancer survivors and supports the use of the DT in providing actionable information on distress and its causes.