Symptom Burden in the First Year After Cancer Diagnosis: An Analysis of Patient-Reported Outcomes

Abstract

Purpose Improvement in the quality of life of patients with cancer requires attention to symptom burden across the continuum of care, with the use of patient-reported outcomes key to achieving optimal care. Yet there have been few studies that have examined symptoms in the early postdiagnosis period during which suboptimal symptom control may be common. A comprehensive analysis of temporal trends and risk factors for symptom burden in newly diagnosed patients with cancer is essential to guide supportive care strategies. Methods A retrospective observational study was performed of patients who were diagnosed with cancer between January 2007 and December 2014 and who survived at least 1 year. Patient-reported Edmonton Symptom Assessment System scores, which are prospectively collected at outpatient visits, were linked to provincial administrative health care data. We described the proportion of patients who reported moderate-to-severe symptom scores by month during the first year after diagnosis according to disease site. Multivariable logistic regression models were constructed to identify risk factors for moderate-to-severe symptom scores. Results Of 120,745 patients, 729,861 symptom assessments were recorded within 12 months of diagnosis. For most symptoms, odds of elevated scores were highest in the first month, whereas nausea had increased odds of elevated scores up to 6 months after diagnosis. On multivariable analysis, cancer site, younger age, higher comorbidity, female sex, lower income, and urban residence were associated with significantly higher odds of elevated symptom burden. Conclusion 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.

Distress in cancer patients: Who are the main groups at risk?

“…This is partially similar to our results. Our data did not confirm Bubis' et al (2018) results who found a significantly higher probability of reporting elevated scores in symptom burden within females and younger patients, in a population‐based cohort of newly diagnosed patients, regardless of cancer sites.…”

Severe symptoms and very low quality-of-life among outpatients newly diagnosed with advanced cancer: data from a multicenter cohort study

“…Online Resources 4 and 5 indicated that tumor site and gender might be associated with patients' burden. In all, women had better POS scores but reported higher values for anxiety and fatigue than male patients which confirms results identified in other studies and underlines the need for a closer look at gender differences in future studies [28][29][30].…”

Patterns of Symptoms Burden in Neuroendocrine Tumors: A Population-Based Analysis of Prospective Patient-Reported Outcomes

“…It fills a gap in the NETs literature regarding PROs. The symptoms most commonly scored moderate‐to‐severe are similar to other types of cancers . However, the symptom trajectory in NETs differs: whereas the odds of high scores decrease with each successive month from diagnosis time in other cancers, the proportion of elevated scores for NETs remains stable over 5 years following diagnosis.…”

“…In order to use this information to design patient support strategies, patient and disease factors associated with the report of moderate-to-severe scores were examined. The association of younger age with higher symptom burden has been reported in patients with cancer, albeit inconsistently [14,15,28]. The impact of comorbidity burden on symptoms is also common to other diseases [29,30].…”