Symptom burden in cancer survivors 1 year after diagnosis: A report from the American Cancer Society's studies of cancer survivors.

Abstract

9041 Background: Cancer survivors are at risk for persistent symptoms stemming from cancer and its treatment, but few studies have assessed the status of multiple symptoms after completion of cancer therapy. We describe symptom burden (SB), associated risk factors, and impact on quality of life (QoL) in a population-based sample of one-year cancer survivors. Methods: Cancer survivors were sampled from 11 state cancer registries and surveyed by telephone or mail approximately one year after diagnosis. Among 4,903 respondents who completed the Modified Rotterdam Symptom Checklist (RSCL-M) and Profile of Mood States-37 (POMS-37), 4,511 reported having symptoms. A two-step cluster analysis further divided those reporting symptoms into two subgroups: those with either low (n = 2,925) or high (n = 1,586) SB. Logistic regression identified medico-demographic risk factors for high SB. In survivors with high SB, symptom profiles were described using factor analysis. The impact of SB on QoL was estimated via ordered logistic regression with the QoL item from the Satisfaction with Life Domains Scale (SLDS) as the dependent variable. Results: Risk factors for high SB were: age less than 55 (OR = 1.92), lower income (OR = 1.62), lower education (OR = 1.30), uninsured/Medicaid (OR = 1.92), ≥1 comorbid condition (OR = 2.15), and previous chemotherapy (OR = 1.36). In survivors with high SB, factor analysis identified 7 factors among RSCL-M items, with fatigue and pain being the most severe. Among POMS-37 subscale items, fatigue and tension were the most severe. QoL was worse in survivors with high SB than in survivors with low SB (p<0.001), with pain and depression-related symptoms having the greatest impact on QoL. Conclusions: One in three cancer survivors reported high SB. Fatigue, pain, and depression were predominant among those with higher SB. The risk factors for high SB described above identified the groups of survivors most in need of symptom-management planning. High SB reported by survivors with minimal health insurance may have health policy implications. The negative impact of SB upon overall QoL underscores the importance of symptoms among survivors. No significant financial relationships to disclose.