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

## TL;DR

This study shows that patients with breast cancer undergoing hormone therapy who report more symptoms or use alternative treatments often have a lower quality of life and need more proactive care.

## Contribution

The study identifies key factors, such as prior chemotherapy and symptom reporting, that influence symptom burden and quality of life in breast cancer patients on hormone therapy.

## Key findings

- Patients with prior chemotherapy or ovarian function suppression had higher symptom burdens.
- Those who reported symptoms or used alternative medicine had lower quality of life.
- Proactive monitoring of symptoms is crucial for improving patient care.

## Abstract

Many women with hormone-sensitive breast cancer undergo long-term hormone therapy to prevent cancer recurrence. While this treatment saves lives, it can cause difficult side effects, such as joint pain, hot flashes, and mood changes, that significantly lower a patient’s quality of life. Patients often do not inform their doctors about these problems until they become severe. This study aimed to understand which patients experience the worst side effects and how their symptom-reporting behaviors relate to their well-being. We surveyed 191 women undergoing this therapy at a hospital in Antalya, Turkey. Our results showed that patients who had previously received chemotherapy or were taking medication to suppress ovarian function had a much higher burden of symptoms. We also found that patients who reported their side effects to their doctor, used alternative medicines, or received psychological support tended to have more severe symptoms and lower quality of life. This suggests that patients who suffer the most actively seek help. This study highlights the importance of proactively asking patients about their side effects rather than waiting for them to report them. By regularly monitoring symptoms, healthcare teams can offer better and more personalized support to improve the daily lives of breast cancer survivors.

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.