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The prevalence and risk of symptom and function clusters in colorectal cancer survivors

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Abstract

Purpose

Our purpose was to describe the prevalence and predictors of symptom and function clusters in a diverse cohort of colorectal cancer survivors.

Methods

We used data from a cohort of 909 adult colorectal cancer survivors. Participants were surveyed at a median of 9 months after diagnosis to ascertain the co-occurrence of eight distinct symptom and functional domains. We used factor analysis to identify co-occurring domains and latent profile analysis (LPA) to identify subgroups of survivors with different symptom and function clusters. Multinomial logistic regression models were used to identify risk/protective factors.

Results

Factor analysis demonstrated a single underlying factor structure that included all eight health domains with depression and anxiety highly correlated (r = 0.87). The LPA identified three symptom and function clusters, with 30% of survivors in the low health-related quality of life (HRQOL) profile having the highest symptom burden and lowest functioning. In multivariable models, survivors more likely to be in the low HRQOL profile included being non-White, female, those with a history of cardiac or mental health conditions, and chemotherapy recipients. Survivors less likely to be in the low HRQOL profile included those with older age, greater financial well-being, and more spirituality.

Conclusion

Nearly one-third of colorectal cancer survivors experienced a cluster of physical and psychosocial symptoms that co-occur with clinically relevant deficits in function.

Implications for Cancer Survivors

Improving the identification of risk factors for having the highest symptom and lowest function profile can inform the development of clinical interventions to mitigate their adverse impact on cancer survivors’ HRQOL.

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Data availability

Data underlying this article are available with permission from the following data repository: Potosky, Arnold L.; Moinpour, Carol, 2016, “PROMIS 2 MY Health”, https://doi.org/10.7910/DVN/XD1A6B, Harvard Dataverse, V1, UNF:6:No/Ha2bxUBEO7nsiGeazsg =  = [fileUNF].

Code availability

Not applicable.

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Acknowledgements

We thank Ms. Felice Yang and Ms. Tania Lobo of the Survey, Recruitment, and Biospecimen Collection Shared Resource (SRBSR) of the Georgetown University Medical Center for their help with data management. We also acknowledge the research assistance of Ms. Debra Henke and Mr. Anthony Chicaiza.

Funding

This work was supported by the following grants from the National Institutes of Health (NIH): R01 NR018841 and U01 AR057971. This research was also supported by the Survivorship Research Initiative of the Georgetown Lombardi Comprehensive Cancer Center (P30-CA051008).

Author information

Authors and Affiliations

  1. Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 2115 Wisconsin Ave NW, Suite 300, Washington, DC, 20007, USA

    Arnold L. Potosky & Kristi D. Graves

  2. Department of Population Health Sciences, Center for Health Measurement, Duke University School of Medicine, Durham, NC, 27701, USA

    Li Lin & Bryce B. Reeve

  3. Department of Population Health Sciences, Duke University School of Nursing, Duke University School of Medicine, Durham, NC, 27701, USA

    Wei Pan

  4. Department of Professional Nursing Practice, School of Nursing & Health Studies, Georgetown University Medical Center, Washington, DC, 20057, USA

    Jane M. Fall-Dickson

  5. Department of Biostatistics, Bioinformatics and Biomathematics, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, 20057, USA

    Jaeil Ahn

  6. MedStar Georgetown University Hospital, Washington, DC, 20007, USA

    Kristin M. Ferguson

  7. Division of Hematology and Oncology, Department of Internal Medicine, University of California-Davis Comprehensive Cancer Center, Sacramento, CA, 95817, USA

    Theresa H. M. Keegan

  8. Rutgers School of Public Health and Cancer Institute of New Jersey, New Brunswick, NJ, 08901, USA

    Lisa E. Paddock

  9. Sciences Center School of Public Health, Louisiana Tumor Registry, Louisiana State University Health, New Orleans, LA, 70112, USA

    Xiao-Cheng Wu

  10. Public Health Institute, Cancer Registry of Greater California, Sacramento, CA, USA

    Rosemary Cress

  11. Duke Cancer Institute, Duke University School of Medicine, Durham, NC, 27710, USA

    Bryce B. Reeve

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  1. Arnold L. Potosky
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  2. Kristi D. Graves
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  3. Li Lin
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  4. Wei Pan
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  5. Jane M. Fall-Dickson
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  7. Kristin M. Ferguson
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  8. Theresa H. M. Keegan
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  9. Lisa E. Paddock
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  10. Xiao-Cheng Wu
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  11. Rosemary Cress
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  12. Bryce B. Reeve
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Contributions

ALP was responsible for funding acquisition, supervision, project administration, data curation, and the original draft; BBR and LL were responsible for formal analysis; BBR, LL, and WP were responsible for methodology; all authors contributed to study conceptualization, and review and editing.

Corresponding author

Correspondence to Arnold L. Potosky.

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An exemption from IRB review was granted by the Georgetown-Medstar Oncology IRB because the project was deemed “not human subjects research” (secondary analysis of de-identified, secondary data).

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The authors declare no competing interests.

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Potosky, A.L., Graves, K.D., Lin, L. et al. The prevalence and risk of symptom and function clusters in colorectal cancer survivors. J Cancer Surviv 16, 1449–1460 (2022). https://doi.org/10.1007/s11764-021-01123-6

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