Symptom Burden High Among Survivors Years After Diagnosis

Patients who’ve survived cancer often report a number of co-occurring symptoms, such as lack of energy and problems with sexual activity. However, a new study was unable to identify any disease or treatment characteristics that were associated with a higher symptom burden.

“Findings from the current study suggested that despite improvements in symptom management interventions, symptom burden remains high in cancer survivors,” Melissa Mazor, RN, PhD, of University of California at San Francisco, and colleagues, wrote in the study published in Cancer. “Research is warranted to evaluate the efficacy of symptom management interventions for these persistent, severe, and distressing symptoms.”

According to the study, the growing number of cancer survivors in the United States has increased attention paid to the persistent adverse effects associated with its treatment. Mazor and colleagues sought to determine if the occurrence, severity, and distress associated with 32 symptoms was linked with a higher symptom burden.

The study evaluated symptom burden among 623 survivors of cancer. Survivors completed a demographic questionnaire, as well as measures of functional status, comorbidity, and global/cancer-related stress.

At the time of the study, survivors were about 4.7 years from their cancer diagnosis. The most common comorbid conditions were back pain, occurring in about one-third of patients, as well as osteoarthritis, high blood pressure, and depression, which occurred in about one-quarter of patients.

The study included patients who had been diagnosed with breast cancer (55.7%), ovarian cancer (8.7%), colon cancer (8.0%), lung cancer (3.0%), and other malignancies (24.6%). The majority of these survivors had undergone prior surgery (92.6%) or radiotherapy (62.7%). All had undergone chemotherapy.

On average, survivors reported 9.1 symptoms, the most common of which was lack of energy. About 70% of survivors reported a lack of energy, pain, and difficulty sleeping. The most severe symptom reported was problems with sexual interest/activity, and the most distressing symptom was hair loss.

“Consistent with the findings of a previous study, approximately 15% of survivors in the current study reported that their fatigue, pain, and sleep disturbance were severe and very distressing,” the researchers wrote. “Given these consistent findings, clinicians need to assess for these 3 symptoms on a routine basis and initiate appropriate interventions.”

Previous research has found up to one-third of survivors of cancer suffer from chronic pain.

The researchers identified three symptoms that ranked within the top 10 symptoms for frequency, severity, and distress: pain, difficulty sleeping, and numbness/tingling in the hands or feet.

Symptom analysis showed that poorer functional status, a higher level of comorbidity, and a history of smoking were all associated with a higher symptom burden. In addition, higher global symptom burden (Perceived Stress Scale) and cancer-specific burden (Impact of Event Scale) were also associated with a higher symptom burden.

"This is an important and well-done study demonstrating the symptom burden in longer term survivors,” Deborah K. Mayer, PhD, RN, AOCN, FAAN, director of Cancer Survivorship at UNC Lineberger Comprehensive Cancer Center, told Cancer Network. “The association of perceived stress and symptom burden is not surprising but provides an opportunity to identify higher risk survivors needing more aggressive management of both symptoms and tools and techniques for stress reduction. It demonstrates the need for ongoing follow-up that addresses these issues to help survivors achieve their optimal quality of life given their cancer, its treatment and other co-occurring illnesses."