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Study of Patient-Reported Symptom Burden in First Year After Cancer Diagnosis

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Key Points

  • For most symptoms, the likelihood of elevated scores was greatest in the month after diagnosis.
  • Factors associated with higher scores consisted of cancer site, younger age, higher comorbidity, female sex, lower income, and urban residence.

In a Canadian retrospective population-based study reported in the Journal of Clinical Oncology, Bubis et al found that patients with cancer reported higher symptom scores at 1 month after diagnosis and identified several factors associated with higher symptom scores.

Study Details

The study involved 729,861 symptom assessments using patient-reported Edmonton Symptom Assessment System scores among 120,745 patients in the Ontario Cancer Registry who were diagnosed with cancer between January 2007 and December 2014 and who survived at least 1 year. The scores are prospectively collected at outpatient visits and linked to provincial administrative health care data. Data were collected on cancers of the oropharynx; gastrointestinal tract; respiratory system; breast; gynecologic system; genitourinary system; nervous system and orbit; and hematologic and lymphatic systems. The study analyzed the proportion of patients reporting moderate to severe symptom scores by month during the first year after diagnosis.

Factors Associated with Higher Symptom Scores

For most symptoms, odds of elevated scores were highest in the first month after diagnosis, whereas odds of elevated nausea scores persisted for up to 6 months. Patients with respiratory and oropharyngeal cancers had the highest incidence of moderate to severe scores across all symptoms, whereas patients with genitourinary cancers had the lowest incidence of elevated scores. Overall, the prevalence of scores indicating presence of a symptom was greater than 75% for anxiety, tiredness, and depression. Proportions of patients reporting moderate to severe scores declined over time for most cancer sites and symptoms. Thus, a large proportion of patients reported elevated anxiety scores across cancer types during the 1–2 months after diagnosis, with the proportion then decreasing until month 6, when it stabilized.

On multivariate analysis, cancer site, younger age, higher comorbidity, female sex, lower income, and urban residence were associated with significantly higher odds of elevated symptom scores.

The investigators concluded, “A high prevalence of moderate-to-severe symptom scores was observed in cancers of all sites. Patients are at risk of experiencing multiple symptoms in the immediate postdiagnosis period, which underscores the need to address supportive care requirements early in the cancer journey. Patient subgroups who are at higher risk of experiencing moderate-to-severe symptoms should be targeted for tailored supportive care interventions.”

The study was supported by the Institute for Clinical Evaluative Sciences, Ontario Ministry of Health and Long-Term Care, a Cancer Care Ontario Clinical Programs and Quality Initiatives grant, and Sherif and MaryLou Hanna Chair in Surgical Oncology Research.

Natalie Coburn, MD, MPH, of Sunnybrook Health Sciences Centre, Toronto, is the corresponding author for the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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