Symptom Burden Among Cancer Survivors: Impact of Age and Comorbidity (original) (raw)
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Supportive Care in Cancer, 2013
Purpose Patients with cancer experience acute and chronic symptoms caused by their underlying disease or by the treatment. While numerous studies have examined the impact of various treatments on symptoms experienced by cancer patients, there are inconsistencies regarding the symptoms measured and reported in treatment trials. This article presents a systematic review of the research literature of the prevalence and severity of symptoms in patients undergoing cancer treatment. Methods A systematic search for studies of persons receiving active cancer treatment was performed with the search terms of "multiple symptoms" and "cancer" for studies involving patients over the age of 18 years and published in English during the years 2001 to 2011. Search outputs were reviewed independently by seven authors, resulting in the synthesis of 21 studies meeting criteria for generation of an Evidence Table reporting symptom prevalence and severity ratings. Results Data were extracted from 21 multinational studies to develop a pooled sample of 4,067 cancer patients in whom the prevalence and severity of individual symptoms was reported. In total, the pooled sample across the 21 studies was comprised of 62 % female, with a mean age of 58 years (range 18 to 97 years). A majority (62 %) of these studies assessed symptoms in homogeneous samples with respect to tumor site (predominantly breast and lung cancer), while 38 % of the included studies utilized samples with mixed diagnoses and treatment regimens. Eighteen instruments and structured interviews were including those measuring single symptoms, multisymptom inventories, and single symptom items drawn from HRQOL or health status measures. The MD Anderson Symptom Inventory was the most commonly used instrument in the studies analyzed (n=9 studies; 43 %), while the Functional Assessment of Cancer Therapy, Hospital Anxiety and Depression Subscale, Medical Outcomes Survey Short Form-36, and Symptom Distress Scale were each employed in two studies. Forty-seven symptoms were identified across the 21 studies which were then categorized into 17 logical groupings. Symptom prevalence and severity were calculated across the entire cohort and also based upon sample sizes in which the symptoms were measured providing the ability to rank symptoms. Conclusions Symptoms are prevalent and severe among patients with cancer. Therefore, any clinical study seeking to evaluate the impact of treatment on patients should consider including measurement of symptoms. This study demonstrates that a discrete set of symptoms is common across cancer types. This set may serve as the basis for defining a "core" set of
The Most Important Factor Influencing Quality of Life Among Cancer-related Psychological Symptoms
Journal of Research and Health, 2024
Background: Despite progress in cancer treatment, patients often experience pain and emotional distress, which can reduce sleep quality and, ultimately, the quality of life (QoL). This study aimed to identify the most important factors influencing QoL among cancer-related psychological symptoms in patients with cancer. Methods: This cross-sectional study with a correlational research design recruited 63 participants with cancer diagnoses from a cancer rehabilitation center in South Korea. Data were collected through convenience sampling between October 2023 and February 2024 using the following questionnaires: The European Organization for Research and Treatment of Cancer Core QoL questionnaire (EORTC QLQ-C30), consisting of 15 items to assess QoL and the breakthrough pain assessment tool (BPAT), brief fatigue inventory (BFI), Beck anxiety inventory (BAI), Beck depression inventory (BDI) and Pittsburgh sleep quality index (PSQI) to measure cancer-related psychological symptoms. Results: Only the fatigue symptom in cancer patients was significantly correlated with all items of the EORTC QLQ-C30, whereas pain was correlated with a relatively small number (five items) of EORTC QLQ-C30 items compared to other psychological symptoms. Additionally, there were moderate to strong correlations between cancer-related pain, fatigue, anxiety, depression and poor sleep quality. Conclusion: Cancer-related psychological symptoms were interrelated, and these symptoms were related to the multidimensional components of QoL. Fatigue was the most important factor influencing the overall QoL. We suggest that healthcare professionals consider a comprehensive approach to improving the QoL of patients with cancer.
Pain, Depression, and Fatigue in Community-Dwelling Adults With and Without a History of Cancer
Journal of Pain and Symptom Management, 2006
The State of the Science Report by the National Cancer Institute on Symptom Management in Cancer identified gaps in understanding the epidemiology of pain, depression, and fatigue, and called for studies that will identify the extent of risk for these symptoms among those with cancer relative to other populations. Using year 2000 data from the Health and Retirement Study, a survey of a nationally representative sample of adults aged $50, we evaluated whether respondents with a history of cancer had excess risk for pain, depression, and fatigue compared to those without a history of cancer. We also compared clustering/co-occurrence of symptoms. Controlling for the confounding effects of comorbidities, sociodemographic, and access to care factors, respondents with a history of cancer had higher risk for fatigue (OR ¼ 1.45; 95%CI ¼ 1.29,1.63), depression (OR ¼ 1.21; 95%CI ¼ 1.06,1.37), and pain (OR ¼ 1.15; 95%CI ¼ 1.03,1.28). Symptom clusters were also more prevalent among those with a history of cancer (P < 0.001), with the pain-depression-fatigue cluster as most prevalent.
Pain and depression in patients with cancer
Cancer, 1994
Background. Although the existence of a relationship between depression and pain in patients with cancer has been known for many years, the influence of one upon the other is still poorly understood. It has been thought that depressed individuals complain of pain more because of their psychiatric illness. Evidence from two studies indicate that pain may induce clinical depression. Methods. In the first study, the authors examined both current and lifetime psychiatric diagnoses among patients with cancer who had high and low pain symptoms to examine the strength of the relationship between depression and cancer pain. The sample consisted of 72 women and 24 men, with 39 women and 9 men in the high pain group, and 33 women and 15 men in the low pain group. In the second study, 35 patients with metastatic carcinoma of the breast were examined for pain intensity and frequency and mood disturbance. Results. The prevalence of depressive disorders of all types was found to be significantly higher in the high pain than in the low pain group across measures, 33 versus 13% (chi-square [degrees of freedom = 11 = 5.90, P < 0.05). Furthermore, there was a significantly higher history of major depression in the low pain group than in the high pain group (chi-square [degrees of freedom = 11 = 3.86, P < 0.05). Also, in comparison with patients in the low pain group, patients in the high pain group were significantly more anxious and emotionally distressed. In the second study, pain intensity correlated significantly with fatigue, vigor, and total mood disturbance, and pain frequency correlated significantly with fatigue, vigor, and depression. Conclusions. This study confirms the high concomi-From the
Symptom Documentation in Cancer Survivors as a Basis for Therapy Modifications
Acta Oncologica, 2002
In order to suggest therapy modi cations with the aim of diminishing the risk of therapy-induced long-term distressful symptom s in cancer survivors, data are needed relating details of therapy to the long-term symptom situation. In this article, the concept s and mean s used to assess the latter while developin g the R adiumhemmet scale for sympto m assessmen t are described. The focus is on the subjective long-term situation, and symptoms as a perceived abnormality are de ned. F or concep tual clarity, one symptom at a time is considered , excluding scales in which items are summarized . M oreover , measures of disease occurrence in the population are translated (epidemiologically) into measures of symptom occurrence in an individual. Nature distinguishes one long-term symptom from another . Occurrence of a symptom in an individual is measured by an incidence (e.g. number of defecations per week) or prevalence rate (e.g. urinations with involuntar y cessation divided by the total number of urinations). Any scale expressing symptom intensity is arbitrary, be it 'verbal' (no:little:moderate:much pain) or visual (analogue or with integers). A time period describes sympto m duration. The relevance of a sympto m to emotions and social activities, sometimes cited as the associated symptom-indu ced distress, is a separate issue from symptom occurrence, intensity, and duration.
Testing the differential effects of symptom management interventions in cancer
Psycho-Oncology, 2014
Objective-The purpose of this study was to test for moderating effects of patient characteristics on self-management interventions developed to address symptoms during cancer treatment. Patient's age, education and depressive symptomatology were considered as potential moderators. Methods-A secondary analysis of data of 782 patients from two randomized clinical trials was performed. Both trials enrolled patients with solid tumors undergoing chemotherapy. After completing baseline interviews, patients were randomized to a nurse-delivered intervention versus intervention delivered by a "coach" in trial I, and to a nurse-delivered intervention versus an intervention delivered by an automated voice response system in trial II. In each of the two trials, following a 6-contact 8-week intervention, patients were interviewed at week 10 to assess the primary outcome of symptom severity. Results-While nurse-delivered intervention proved no better than the "coach" or automated system in lowering symptom severity, important differences in the intervention by age were found in both trials. Patients ≤45 years responded better to the "coach" or automated system; while those ≥75 years favored the nurse. Education and depressive symptomatology did not modify the intervention effects in either of the two trials. Depressive symptomatology had a significant main effect on symptom severity at week 10 in both trials (p=.03 and p<.01, respectively). Education was not associated with symptom severity over and above age and depressive symptomatology. Conclusions-Clinicians need to carefully consider the age of the population when using or testing interventions to manage symptoms among cancer patients.