Symptom Reporting Behaviors, Symptom Burden, and Quality of Life in Patients with Hormone Receptor–Positive Breast Cancer Undergoing Adjuvant Endocrine Therapy

Abstract

Background: Adjuvant endocrine therapy (AET) enhances survival outcomes in hormone receptor–positive (HR+) breast cancer. However, this treatment is associated with toxicities that may adversely affect the quality of life (QoL) and impact patient–physician communication. A thorough understanding of symptom-reporting behaviors is essential for optimizing survivorship care. Methods: This cross-sectional study surveyed 191 female patients with HR+ breast cancer undergoing adjuvant AET (tamoxifen or aromatase inhibitors ± ovarian function suppression [OFS]) at Antalya Training and Research Hospital between July and August 2025. QoL, symptom burden, and adverse event (AE) reporting behaviors were assessed using validated instruments (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 [EORTC QLQ-C30], adapted Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events [PRO-CTCAE]). Categorical variables were compared using chi-square tests, and multivariate analyses were performed using logistic regression. Results: The median age was 54 years (interquartile range [IQR]: 46–61 years). The following independent variables were identified as predictors of a higher symptom burden: prior chemotherapy (odds ratio [OR]: 3.75; 95% confidence interval [CI]: 1.46–9.69; p = 0.006), OFS use (OR: 3.29; 95% CI: 1.51–7.15; p = 0.003), AE reporting to physicians (OR: 3.52; 95% CI: 1.80–6.88; p < 0.001), and complementary and alternative medicine (CAM) use (OR: 7.27; 95% CI: 1.57–33.63; p = 0.011). Independent predictors of poor QoL included receiving psychological support (OR: 0.36; 95% CI: 0.19–0.67; p = 0.002) and AE reporting (OR: 0.28; 95% CI: 0.13–0.64; p = 0.001). Conclusions: Symptom burden and QoL in patients with HR+ breast cancer receiving AET are influenced by clinical history, including chemotherapy and OFS; behavioral factors, such as reporting behaviors; and supportive care, including CAM and psychological support. The routine integration of patient-reported outcomes and proactive symptom monitoring is crucial for delivering personalized and effective survivorship care.