Perceptions of Patients With Breast and Colon Cancer of the Management of Cancer-Related Pain, Fatigue, and Emotional Distress in Community Oncology

Abstract

PURPOSE Pain, fatigue, and distress are common among patients with cancer but are often underassessed and undertreated. We examine the prevalence of pain, fatigue, and emotional distress among patients with cancer, as well as patient perceptions of the symptom care they received. PATIENTS AND METHODS Seventeen Commission on Cancer–accredited cancer centers across the United States sampled patients with local/regional breast (82%) or colon (18%) cancer. We received 2,487 completed surveys (61% response rate). RESULTS Of patients, 76%, 78%, and 59% reported talking to a clinician about pain, fatigue, and distress, respectively, and 70%, 61%, and 54% reported receiving advice. Sixty-one percent of patients experienced pain, 74% fatigue, and 46% distress. Among those patients experiencing each symptom, 58% reported getting the help they wanted for pain, 40% for fatigue, and 45% for distress. Multilevel logistic regression models revealed that patients experiencing symptoms were significantly more likely to have talked about and received advice on coping with these symptoms. In addition, patients who were receiving or recently completed curative treatment reported more symptoms and better symptom care than did those who were further in time from curative treatment. CONCLUSION In our sample, 30% to 50% of patients with cancer in community cancer centers did not report discussing, getting advice, or receiving desired help for pain, fatigue, or emotional distress. This finding suggests that there is room for improvement in the management of these three common cancer-related symptoms. Higher proportions of talk and advice among those experiencing symptoms imply that many discussions may be patient initiated. Lower rates of talk and advice among those who are further in time from treatment suggest the need for more assessment among longer-term survivors, many of whom continue to experience these symptoms. These findings seem to be especially important given the high prevalence of these symptoms in our sample.

Symptom burden among older breast cancer survivors: The Thinking and Living With Cancer (TLC) study

“…It has been more than a decade since the Institute of Medicine highlighted the unmet needs of cancer survivors, but 50% of survivors still report not getting help to address symptoms . These data, together with our findings, suggest that survivorship care should emphasize screening for and discussion of symptoms, including sleep difficulties, depression, anxiety, pain, and fatigue, especially because these symptoms are actionable.…”

“…It has been more than a decade since the Institute of Medicine highlighted the unmet needs of cancer survivors, 24 but 50% of survivors still report not getting help to address symptoms. 25 These data, together with our findings, suggest that survivorship care should emphasize screening for and discussion of symptoms, including sleep difficulties, depression, anxiety, pain, and fatigue, 26 especially because these symptoms are actionable. System-level interventions like chart reminders might increase symptom screening, because oncologists with training about cancer-related symptoms or those who use electronic records with prompts are more likely to talk to survivors about care needs.…”

Knowledge, perceptions, and management of cancer-related fatigue: the patients' perspective

“…These shortcomings in fatigue management do not exclusively exist in Germany. There are also reports from other countries suggesting that recommendations and guidelines for education, systematic screening, in-depth fatigue evaluation, and therapy of fatigue have not yet been implemented in practice [ 8 , 9 , 26 , 27 ].…”

<p>ATAS Acupuncture Reduces Chemotherapy Induced Fatigue in Breast Cancer Through Regulating ADROA1 Expression: A Randomized Sham-Controlled Pilot Trial</p>

“…A survey showed that 61% of cancer patients experienced pain, 74% of cancer patients experienced fatigue, and 46% of cancer patients experienced distress. 21 Hence, targeting women at risk for severe fatigue is essential to increase the life quality of breast cancer patients. A study which characterized cyclical variations in fatigue across a taxane-based chemotherapy cycle showed that fatigue increased from baseline to prior to the third treatment, then peaked at 3-5 days after the third treatment, before recovering prior to the next treatment.…”