Symptom Burden Among Cancer Survivors: Impact of Age and Comorbidity
Background: Previous research among specific cancer populations has shown high but variable symptom burden; however, very little is known about its extent and pattern among the entire population of US cancer survivors, which is more clinically relevant to primary care physicians.
Methods: To determine the prevalence of ongoing symptom burden among cancer survivors and compare it with the general population without cancer, we analyzed data from the 2002 National Health Interview Survey, which included 1,904 cancer survivors and 29,092 controls. Main outcome measures included self-reported ongoing pain, psychological distress, and insomnia. Multivariate logistic regression models were used to adjust for confounders and test for interactions.
Results: The rates of ongoing pain, psychological distress, and insomnia among cancer survivors were 34%, 26%, and 30%, respectively, and were significantly higher (all P < .001) than controls without a history of cancer (18%, 16%, and 17%). Compared with controls in the same age groups, younger survivors (younger than 50) were much more likely to report ongoing symptoms than older survivors (older than 64); adjusted odds ratios were 2.96 and 1.36 for pain in the respective age groups (P < .001). Comorbidities also interact with cancer status and contribute to a marked increase in reports of ongoing symptom burden among cancer survivors, with a greater number of comorbidities leading to greater degree of symptom burden in a dose-dependent manner (P < .001).
Conclusions: The symptom burden among cancer survivors on a population level is substantial and can be impacted by other comorbidities. Thus, engaging primary care physicians in the design, testing, and implementation of effective interventions is important to reduce the symptom burden among cancer survivors.
Despite the importance of symptom research in cancer, the existing literature is limited. Most previous studies used small and highly selected clinical populations such as patients in specialty clinics in comprehensive cancer centers. On a population level, very little is known about the extent of symptom burden among people with a previous cancer diagnosis, especially when compared with people without cancer or with other chronic diseases. Furthermore, because early detection and treatment advances have transformed cancer into a chronic disease for many patients, people with a cancer diagnosis are increasingly likely to interact with primary care physicians in settings outside of specialty clinics in large academic centers. A population-based study is needed to understand the symptom burden among cancer survivors on a community level. Thus, the specific objectives of this study are (1) to estimate the prevalence of ongoing symptoms such as recurring pain, frequent depression and anxiety, and regular insomnia among cancer survivors in a large nationally representative sample; (2) to quantify the magnitude of symptom burden among cancer survivors by a comparison with the general population without cancer; and (3) to understand the impact of comorbidity on symptom burden among cancer survivors.
Mao, J. J.,
Bowman, M. A.,
Xie, S. X.,
& Farrar, J. T.
(2007). Symptom Burden Among Cancer Survivors: Impact of Age and Comorbidity. Journal of the American Board of Family Medicine, 20 (5), 434-443.