Recurrence risk perception and quality of life after treatment of breast cancer.

175 Background: Many breast cancer patients overestimate their risk of distant recurrence after treatment. We explored risk perception in a large, diverse population of breast cancer patients with favorable prognosis and assessed associations between overestimation and quality of life (QoL).

METHODS: As part of the iCanCare Study, we surveyed a weighted random sample of newly diagnosed patients with early-stage breast cancer treated in 2013-14, identified through the population-based SEER registries of Los Angeles & Georgia about 3 months after surgical treatment (N = 2632, RR = 70%). Actual 10-year risk of distant recurrence after treatment was determined for women with DCIS (N = 502), and with low risk invasive (LRI: N = 520, Stg 1A, ER+HER2-, Gr 1-2). Women reported perceptions of their risk numerically between 0 - 100%, with values > 10% for DCIS and > 20% for LRI considered substantial overestimates. We assessed which patient and treatment factors were correlated with overestimation and report the bivariable associations between overestimation and the QoL measures of worry, distress, & PROMIS physical and mental health.

RESULTS: One third (36%) of DCIS and 25% of women with LRI breast cancer substantially overestimated their risk of distant recurrence. Overestimation of risk was significantly associated with lower education (p = 0.02), and marginally with lower acculturation (p = 0.08). DCIS patients were more likely to overestimate risk of distant recurrence than LRI patients (OR = 2.0, 95% CI: 1.4-2.7). Women who overestimated risk in both groups reported more worry about recurrence; 49% vs. 16% DCIS, p < 0.001 and 54% vs. 24% LRI, p < 0.001. These women more often had higher distress (0-10 scores, mean of 3.5 vs. 2.5 DCIS p < 0.001, and 3.9 vs. 2.2 for LRI, p < 0.0001) and had poor PROMIS physical (21% vs. 14% DCIS, p < 0.001; 34% vs. 16% LRI, p < 0.001) and mental health (13% vs. 11% DCIS, not significant; 21% vs. 7% LRI, p < 0.001) scores.

CONCLUSIONS: Marked overestimation of risk after treatment was common, particularly among women with very low risk (DCIS). The strong association between risk overestimates and lower QoL suggests the need to address women's perception of risk of distant recurrence after treatment of breast cancer.

FUNDING: P01CA163233.