{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T15:53:28Z","timestamp":1779292408245,"version":"3.51.4"},"reference-count":32,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T00:00:00Z","timestamp":1761264000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Current Oncology"],"abstract":"<jats:p>Background: Adjuvant endocrine therapy (AET) enhances survival outcomes in hormone receptor\u2013positive (HR+) breast cancer. However, this treatment is associated with toxicities that may adversely affect the quality of life (QoL) and impact patient\u2013physician 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 \u00b1 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\u201361 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\u20139.69; p = 0.006), OFS use (OR: 3.29; 95% CI: 1.51\u20137.15; p = 0.003), AE reporting to physicians (OR: 3.52; 95% CI: 1.80\u20136.88; p &lt; 0.001), and complementary and alternative medicine (CAM) use (OR: 7.27; 95% CI: 1.57\u201333.63; p = 0.011). Independent predictors of poor QoL included receiving psychological support (OR: 0.36; 95% CI: 0.19\u20130.67; p = 0.002) and AE reporting (OR: 0.28; 95% CI: 0.13\u20130.64; 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.<\/jats:p>","DOI":"10.3390\/curroncol32110599","type":"journal-article","created":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T05:48:46Z","timestamp":1761716926000},"page":"599","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Symptom Reporting Behaviors, Symptom Burden, and Quality of Life in Patients with Hormone Receptor\u2013Positive Breast Cancer Undergoing Adjuvant Endocrine Therapy"],"prefix":"10.3390","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0930-1016","authenticated-orcid":false,"given":"Ece","family":"Ulukal Karanci","sequence":"first","affiliation":[{"name":"Department of Clinical Oncology, Antalya Education and Research Hospital, University of Health Sciences, 07100 Antalya, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Halil G\u00f6ksel","family":"G\u00fczel","sequence":"additional","affiliation":[{"name":"Department of Clinical Oncology, Antalya Education and Research Hospital, University of Health Sciences, 07100 Antalya, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0290-8787","authenticated-orcid":false,"given":"Banu","family":"\u00d6zt\u00fcrk","sequence":"additional","affiliation":[{"name":"Department of Clinical Oncology, Antalya Education and Research Hospital, University of Health Sciences, 07100 Antalya, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,24]]},"reference":[{"key":"ref_1","first-page":"209","article-title":"Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Early Breast Cancer Trialists\u2019 Collaborative Group (EBCTCG) (2015). Aromatase inhibitors versus tamoxifen in early breast cancer: Patient-level meta-analysis of the randomized trials. Lancet, 386, 1341\u20131352.","DOI":"10.1016\/S0140-6736(15)61074-1"},{"key":"ref_3","unstructured":"National Comprehensive Cancer Network (2025, August 31). NCCN Clinical Practice Guidelines in Oncology: Breast Cancer. Version 4.2023. Available online: https:\/\/www.nccn.org."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1016\/S0140-6736(12)61963-1","article-title":"Adjuvant Tamoxifen: Longer Against Shorter (ATLAS) Collaborative Group. Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of estrogen receptor\u2013positive breast cancer: ATLAS, a randomized trial","volume":"381","author":"Davies","year":"2013","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1056\/NEJMoa1803164","article-title":"SOFT and TEXT Investigators and International Breast Cancer Study Group. Tailoring adjuvant endocrine therapy for premenopausal breast cancer","volume":"379","author":"Francis","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"dju244","DOI":"10.1093\/jnci\/dju244","article-title":"Development of the National Cancer Institute\u2019s patient-reported outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE)","volume":"106","author":"Basch","year":"2014","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1001\/jamaoncol.2015.2639","article-title":"Validity and reliability of the US National Cancer Institute\u2019s patient-reported outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE)","volume":"1","author":"Dueck","year":"2015","journal-title":"JAMA Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"104416","DOI":"10.1016\/j.breast.2025.104416","article-title":"Side-effects in women treated with adjuvant endocrine therapy for breast cancer","volume":"80","author":"Rademaker","year":"2025","journal-title":"Breast"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Ibrar, M., Peddie, N., Agnew, S., Diserholt, A., and Fleming, L. (2022). Breast Cancer Survivors\u2019 Lived Experience of Adjuvant Hormone Therapy: A Thematic Analysis of Medication Side Effects and Their Impact on Adherence. Front. Psychol., 13.","DOI":"10.3389\/fpsyg.2022.861198"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1093\/jnci\/85.5.365","article-title":"The European Organization for Research and Treatment of Cancer QLQ-C30: A quality-of-life instrument for use in international clinical trials in oncology","volume":"85","author":"Aaronson","year":"1993","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2756","DOI":"10.1200\/JCO.1996.14.10.2756","article-title":"The European Organization for Research and Treatment of Cancer breast cancer\u2013specific quality-of-life module (QLQ-BR23): First results from a three-country field study","volume":"14","author":"Sprangers","year":"1996","journal-title":"J. Clin. Oncol."},{"key":"ref_12","first-page":"e2400351","article-title":"Adherence to Adjuvant Endocrine Therapy in Patients With Nonmetastatic Estrogen Receptor-Positive Breast Cancer: A Comprehensive Brazilian Real-World Data Study","volume":"11","author":"Resende","year":"2025","journal-title":"JCO Glob. Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2135","DOI":"10.1002\/ijc.70020","article-title":"Patient-reported outcome thresholds and their associations with survival, adverse events, and quality of life in a pooled analysis of breast cancer trials","volume":"157","author":"Menz","year":"2025","journal-title":"Int. J. Cancer"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"848","DOI":"10.1016\/S1470-2045(15)00049-2","article-title":"Patient-reported outcomes with adjuvant exemestane plus ovarian function suppression versus tamoxifen plus ovarian function suppression in premenopausal women with early breast cancer: A combined analysis of the TEXT and SOFT trials","volume":"16","author":"Bernhard","year":"2015","journal-title":"Lancet Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1601","DOI":"10.1200\/JCO.2015.64.8675","article-title":"Adjuvant tamoxifen with or without ovarian function suppression in premenopausal women with early breast cancer: Patient-reported outcomes in the TEXT and SOFT trials","volume":"34","author":"Ribi","year":"2016","journal-title":"J. Clin. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"4261","DOI":"10.1200\/JCO.2004.08.029","article-title":"Quality of life of postmenopausal women in the Arimidex, Tamoxifen, Alone or in Combination adjuvant breast cancer trial","volume":"22","author":"Fallowfield","year":"2004","journal-title":"J. Clin. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1016\/S1470-2045(06)70910-X","article-title":"Patient versus clinician symptom reporting using the National Cancer Institute Common Terminology Criteria for Adverse Events: Results of a questionnaire-based study","volume":"7","author":"Basch","year":"2006","journal-title":"Lancet Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"910","DOI":"10.1200\/JCO.2014.57.9334","article-title":"Symptomatic toxicities experienced during anticancer treatment: Agreement between patient and physician reporting in three randomized trials","volume":"33","author":"Gallo","year":"2015","journal-title":"J. Clin. Oncol."},{"key":"ref_19","unstructured":"National Cancer Institute (2025, September 01). Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE), Available online: https:\/\/healthcaredelivery.cancer.gov\/pro-ctcae\/."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1200\/JCO.2011.40.8922","article-title":"Effects of psycho-oncologic interventions on emotional distress and quality of life in adult patients with cancer: Systematic review and meta-analysis","volume":"31","author":"Faller","year":"2013","journal-title":"J. Clin. Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2531","DOI":"10.1002\/cam4.3794","article-title":"Symptom clusters experienced by breast cancer patients at various treatment stages: A systematic review","volume":"10","author":"So","year":"2021","journal-title":"Cancer Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1177\/01939459211012426","article-title":"Characteristics of Cancer Symptom Clusters Reported through a Patient-Centered Symptom Cluster Assessment","volume":"44","author":"Kwekkeboom","year":"2022","journal-title":"West. J. Nurs. Res."},{"key":"ref_23","first-page":"598","article-title":"Symptom burden and symptom clusters in patients with breast cancer undergoing endocrine therapy: A cross-sectional survey","volume":"33","author":"Han","year":"2025","journal-title":"Support. Care Cancer"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1016\/j.jgo.2018.11.008","article-title":"Higher symptom burden is associated with lower function in women taking adjuvant endocrine therapy for breast cancer","volume":"10","author":"Sitlinger","year":"2019","journal-title":"J. Geriatr. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"95","DOI":"10.4103\/IJPC.IJPC_183_19","article-title":"The effect of complementary and alternative medicine on the quality of life of patients with breast cancer: A systematic review","volume":"26","author":"Bakhshi","year":"2020","journal-title":"Indian J. Palliat. Care"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Yen, C., Zhao, F., Yu, Z., Zhu, X., and Li, C.G. (2022). Interactions Between Natural Products and Tamoxifen in Breast Cancer: A Comprehensive Literature Review. Front. Pharmacol., 13.","DOI":"10.3389\/fphar.2022.847113"},{"key":"ref_27","unstructured":"Oncology Nursing Society (2025, September 01). Complementary and Integrative Therapies in Supportive Care: Levels of Evidence and Recommendations. Available online: https:\/\/www.ons.org."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1001\/jama.2017.7156","article-title":"Overall survival results of a trial assessing patient-reported outcomes for symptom monitoring during routine cancer treatment","volume":"318","author":"Basch","year":"2017","journal-title":"JAMA"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e2225485","DOI":"10.1001\/jamanetworkopen.2022.25485","article-title":"Racial Differences in Patient-Reported Symptoms and Adherence to Adjuvant Endocrine Therapy Among Women With Early-Stage, Hormone Receptor-Positive Breast Cancer","volume":"5","author":"Hu","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1158\/1055-9965.EPI-20-0604","article-title":"Race and Patient reported Symptoms in Adherence to Adjuvant Endocrine Therapy: A Report from the Women\u2019s Hormonal Initiation and Persistence Study","volume":"30","author":"Sheppard","year":"2021","journal-title":"Cancer Epidemiol. Biomark. Prev."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1007\/s10549-017-4417-z","article-title":"Cross-cultural comparison of breast cancer patients\u2019 Quality of Life in the Netherlands and Japan","volume":"166","author":"Fischer","year":"2017","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_32","unstructured":"European Organization for Research and Treatment of Cancer, Quality of Life Group (2025, September 01). Update on the Breast Cancer\u2013Specific Module (EORTC QLQ-BR45). Available online: https:\/\/www.eortc.org\/app\/uploads\/sites\/2\/2018\/08\/Specimen-BR45-English.pdf."}],"container-title":["Current Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1718-7729\/32\/11\/599\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T06:52:16Z","timestamp":1761720736000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1718-7729\/32\/11\/599"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,24]]},"references-count":32,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["curroncol32110599"],"URL":"https:\/\/doi.org\/10.3390\/curroncol32110599","relation":{},"ISSN":["1718-7729"],"issn-type":[{"value":"1718-7729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,24]]}}}