Critical survivorship challenges among breast cancer survivors in a low- and middle-income country: A tertiary cancer center experience from Southern India.

Abstract

e24136 Background: With improving breast cancer survival, long-term survivorship care needs are increasing steadily. Data from low- and middle-income countries (LMICs) remain limited despite accounting for a substantial proportion of global breast cancer survivors. Understanding context-specific survivorship challenges is essential for effective survivorship care delivery models. This study aimed to identify interim data that is prevalent and potentially modifiable for survivorship challenges among breast cancer survivors at a tertiary cancer centre in Southern India. Methods: This cross-sectional observational study included 56 non-metastatic breast cancer survivors who had completed definitive treatment at least three months before assessment. Survivorship needs were evaluated using a culturally adapted, bilingual, validated 24-item questionnaire assessing physical, emotional, cognitive, sexual, lifestyle, and financial domains on a 5-point frequency scale. Descriptive analyses were performed. Results: The 56 survivors were evaluated at a median follow-up of 31.5 (range 9–117) months from diagnosis, with a median age of 40 (range 27–72) years. Most underwent modified radical mastectomy (89%) and received adjuvant chemotherapy (86%). At assessment, 82% were receiving adjuvant endocrine therapy (median 23 mths). Survivorship challenges were predominantly related to physical recovery and lifestyle disruption. Persistent fatigue and reduced physical activity were reported by 43% of survivors, while musculoskeletal pain and sleep disturbance each affected 41%, clustering as post-treatment physical deconditioning. Financial toxicity was prominent, with 71% reporting financial concerns at least sometimes. Domain-wise analysis showed the burden in financial toxicity and lifestyle impact among 89.2% of survivors, followed by emotional well-being and fear of recurrence (17.6%), cognitive concerns (14.3%), physical symptoms (12.5%), and fatigue or sleep disturbance (10.7%). Sexual and reproductive health concerns were rarely reported, suggesting sociocultural under-reporting. Conclusions: Breast cancer survivors in this LMIC cohort demonstrate a distinct survivorship burden profile dominated by financial toxicity, physical deconditioning and lifestyle disruption with relatively low prevalence of sexual life problems. These findings underscore a mismatch between Western models and survivor priorities in resource-constrained settings. At the institutional level, these results will be used to refine survivorship-focused clinical workflows addressing the most distressing domains during routine oncology follow-up.