SYMPTOM CLUSTER SEVERITY AND RELATIONSHIP TO GASTROINTESTINAL MICROBIOME IN WOMEN WITH BREAST CANCER RECEIVING CHEMOTHERAPY

Catherine Cherwin; Jemmie Hoang; Ashutosh Mangalam

Despite pharmacologic management, symptoms in people with cancer remain prevalent and severe. Research has shown that people with cancer receiving chemotherapy experience as many as 15 concurrent symptoms, often as part of a symptom cluster. While some contributors to symptom severity are well documented, such as emetogenicity of chemotherapy, many remain undescribed. Emerging evidence suggests that the bacteria of the gut, known as the GI microbiome, may also influence symptom severity. Reduced microbial diversity is associated with severe GI symptoms like nausea, diarrhea, and oral mucositis in people with cancer. However, the connection between GI microbiome and symptom clusters remains unknown. The purpose was to describe symptom clusters in women with breast cancer receiving chemotherapy and explore if changes in the microbiome may contribute to symptom cluster severity. Seven days after receiving chemotherapy, 60 women with breast cancer completed a 41-symptom questionnaire based on the modified Memorial Symptom Assessment Scale (MSAS) and collected a stool sample using an Omnigene stool kit. Exploratory factor analysis using severity ratings will be used to identify symptom clusters in breast cancer patients. For each symptom cluster identified, we will calculate an average severity score based on component symptoms in that symptom cluster and categorize each participant as having low, moderate, or high severity. Omnigene kits will be analyzed using 16s analysis and absolute numbers and relative percentages of GI bacteria will be quantified. Associations between bacteria and symptom cluster score will be calculated using regression analysis. Participant recruitment has concluded, and we are analyzing data. Results will be reported regarding sample characteristics, symptom clusters present in the sample, microbiome analysis, and relationship between bacteria and symptom cluster severity score. Poorly managed symptom clusters can lead to interference with activities of daily living, reduced quality of life, and reduced survival. One potential mechanism driving symptom severity is alterations in the GI microbiome due to cancer-chemotherapy. Describing specific biologic mechanisms responsible for GI symptom severity and could lead to novel symptom management interventions. Much of the microbiome-related research involves risk for disease and few studies explore its connection to symptom burden. The innovation of this work is that it will use chemotherapy-associated changes in the microbiome to explore specific microbial differences associated with high symptom cluster severity.

SYMPTOM CLUSTER SEVERITY AND RELATIONSHIP TO GASTROINTESTINAL MICROBIOME IN WOMEN WITH BREAST CANCER RECEIVING CHEMOTHERAPY

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