Long-term outcomes for breast cancer survivors

20 Nov 2018

Two systematic reviews assessing long-term outcomes in survivors of breast cancer have recently been published by members of the EHR research group.

Anthony Matthews and colleagues collated substantial randomised controlled trial and observational evidence on the effect of endocrine therapies on several specific cardiovascular diseases. 26 studies were identified, with results for seven specific cardiovascular disease outcomes. Results suggested an increased risk of venous thromboembolism in tamoxifen users compared with both non-users and aromatase inhibitor users. Results were also consistent with a higher risk of the vascular diseases myocardial infarction and angina in aromatase inhibitor users compared with tamoxifen users, but there was also a suggestion that this may be partly driven by a protective effect of tamoxifen on these outcomes. Data were limited, and evidence was generally inconsistent for all other cardiovascular disease outcomes. This review shows that although the choice of aromatase inhibitor or tamoxifen will primarily be based on the effectiveness against the recurrence of breast cancer, the individual patient’s risk of venous or arterial vascular disease should be an important secondary consideration. The full article was published in the BMJ.

Helena Carreira and colleagues looked at adverse mental health outcomes in women with a history of breast cancer. The authors reviewed 60 studies that compared adverse mental health outcomes in women with a history of breast and in women who never had cancer. The results showed compelling evidence of an increased risk of anxiety, depression and suicide, and neurocognitive and sexual dysfunctions in breast cancer survivors compared with women with no prior cancer. Evidence for other outcomes is scarcer, but breast cancer survivors have also been reported at increased risk of sleep disturbance and stress-related disorders including post-traumatic stress disorder. This review also highlighted that further population-based and longitudinal research would help to better characterize these associations, as approximately one-half of the studies were at high risk of selection bias and confounding by socio-economic status. The full article was published in the Journal of the National Cancer Institute.