Investigating ctDNA testing in breast cancer and its connection to stress and anxiety.

Abstract

e12540 Background: Molecular residual disease (MRD) assessment in breast cancer by circulating tumor DNA (ctDNA) has shown great promise in predicting recurrence risk. Knowledge of ctDNA testing provides reassurance to early stage patients about active disease surveillance. We aimed to determine whether there was any association between ctDNA testing and patient-reported stress, and anxiety. Methods: A prospective study was conducted to test ctDNA in stage I-III breast cancer patients treated at Roswell Park Comprehensive Cancer Center from 2022 to 2024. Peripheral blood samples were collected for serial ctDNA analysis using a personalized, tumor-informed assay (Signatera). Control patients (where ctDNA testing was not performed) who were age and stage matched to those undergoing ctDNA testing were identified. Anxiety and stress were measured using a site-specific psychosocial screen, distress screen, and the presence of active benzodiazepine/antidepressant use. Statistical comparisons were made using the Wilcoxon rank-sum test and Fisher’s exact test, as appropriate, along with multivariate logistic regression in RStudio version 4.4.2, at a significance level of p ≤ 0.05. Results: A total of 82 patients, including 41 ctDNA and 41 control patients with stage I-III breast cancer, were followed from 2022 to 2024. Patients undergoing ctDNA testing had it performed in the neoadjuvant setting or adjuvant setting after the completion of locoregional and systemic treatments. Among patients where ctDNA test was performed, 56% had stage I disease, 22% stage II, and 22% stage III. In the control group, 49% had stage I, 32% stage II, and 22% stage III. ctDNA testing was conducted every 3 months, with a median of 6 tests per patient (range: 3 to 13). Higher ctDNA levels were observed in patients with T3 versus T1 disease (226 MTM/mL vs. 100.8 MTM/mL, p = 0.034). No significant differences were observed in psychosocial screen score, distress screen score, or active benzodiazepine/antidepressant use between control and ctDNA patients. Conclusions: This pilot study demonstrates the feasibility of ctDNA testing in clinical practice. Further studies with larger patient populations and longer follow-up periods are needed to understand the impact of ctDNA testing on the well-being of breast cancer patients.