Mandelblatt, Jeanne S.Zhai, WantingAhn, JaeilSmall, Brent J.Ahles, Tim A.Carroll, Judith E.Denduluri, NeelimaDilawari, AsmaExtermann, MartineGraham, DeenaHurria, ArtiIsaacs, ClaudineJacobsen, Paul B.Jim, Heather S. L.Luta, GeorgeMcDonald, Brenna C.Patel, Sunita K.Root, James C.Saykin, Andrew J.Tometich, Danielle B.Zhou, XingtaoCohen, Harvey J.2020-07-202020-07-202020-03-15Mandelblatt, J. S., Zhai, W., Ahn, J., Small, B. J., Ahles, T. A., Carroll, J. E., Denduluri, N., Dilawari, A., Extermann, M., Graham, D., Hurria, A., Isaacs, C., Jacobsen, P. B., Jim, H., Luta, G., McDonald, B. C., Patel, S. K., Root, J. C., Saykin, A. J., Tometich, D. B., … Cohen, H. J. (2020). Symptom burden among older breast cancer survivors: The Thinking and Living With Cancer (TLC) study. Cancer, 126(6), 1183–1192. https://doi.org/10.1002/cncr.32663https://hdl.handle.net/1805/23282Background: Little is known about longitudinal symptom burden and its consequences for well-being, and if lifestyle moderates burden in older survivors. Methods: We report on 36-month data from survivors 60+ with newly diagnosed non-metastatic breast cancer and non-cancer controls recruited August 2010-June 2016. Symptom burden was a sum of self-reported symptoms/diseases: pain (yes/no), fatigue (FACT-fatigue), cognitive (FACT-cog), sleep problems (yes/no), depression (CES-D), anxiety (STAI), and cardiac problems and neuropathy (yes/no). Well-being was measured using the FACT-G, scaled from 0–100. Lifestyle included smoking, alcohol use, BMI, physical activity, and leisure activities. Mixed models assessed relationships between treatment group (chemotherapy +/− hormonal, hormonal only, control) and symptom burden, lifestyle, and covariates. Separate models tested the effects of fluctuations in symptom burden and lifestyle on function. Results: All groups reported high baseline symptoms, and levels remained high over time; survivor-control differences were most notable for cognitive and sleep problems, anxiety, and neuropathy. The adjusted burden score was highest among chemotherapy-exposed survivors, followed by hormonal therapy vs. controls (p<.001). Burden score was related to physical, emotional, and functional well-being (e.g., survivors with lower vs. higher burden scores had 12.4-point higher physical well-being score). The composite lifestyle score was not related to symptom burden or well-being, but physical activity was significantly associated with each outcome (<.005). Conclusions: Cancer and its treatments are associated with a higher level of actionable symptoms and greater loss of well-being over time in older breast cancer survivors than comparable non-cancer populations, suggesting the need for surveillance and opportunities for intervention.en-USPublisher PolicyBreast cancerSymptom burdenOlder patientsSurvivorshipWell-beingArticle