Abstract P2-13-21: Predicting symptoms and diseases after breast cancer treatment: Development of a nomogram

Background: Women with breast cancer can experience a variety of late adverse effects, depending on age, treatment and time since diagnosis. We developed a nomogram that predicts which symptoms and diseases are likely to occur in breast cancer survivors up to 15 years after diagnosis. Methods: Data from the Netherlands Cancer Registry and NIVEL Primary Care Database were combined in the Primary-Secondary Cancer Care Registry, containing data about the cancer diagnosis/treatment and data from the primary care electronic health records of 12.850 Dutch women diagnosed with breast cancer between 2000-2016. From Nivel Primary Care Database 25.700 control women without breast cancer were obtained. First, Cox regression models were built, stratified by 4 age groups and 2 time windows (1-5 and 5-15 years after diagnosis), in order to determine which symptoms and diseases were more frequently experienced in cases compared to controls (p-value<.05). Second, for each significant symptom and disease, relevant treatment variables (chemo therapy (yes/no), radio therapy (yes/no, and lateralisation), hormone therapy (yes/no), axillary dissection (yes/no)) were added stepwise to the models. Variables with a p-value <.10 were included in a multivariate model and all variables with a p-value <.05 were retained in the final model. Findings: In total, 635 models were constructed, forming the basis for the nomogram. Late effects occurring more frequently in cases compared to controls independent of age and time since diagnosis were chest symptoms, lymphedema/arm symptoms, redness/infections of the skin, nausea, cystitis, insomnia and discussing euthanasia. Others were predominantly relevant 1-5 years after diagnosis, including vomiting and side-effects of medication. Interpretation: This nomogram can provide clinicians and women with breast cancer insight in which symptoms and diseases she has an increased risk to experience in the upcoming years, which is both applicable when making treatment decisions and at follow-up initiation. Besides, it may be a starting point to develop effective preventive measures to limit late side-effects of breast cancer and improve after care for women with breast cancer.

Citation Format: Marianne J. Heins, Kelly M. De Ligt, Janneke Verloop, Sabine Siesling, Joke C. Korevaar. Predicting symptoms and diseases after breast cancer treatment: Development of a nomogram [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-13-21.