Abstract
Objective
The purpose of this study was to determine the association of physical and psychological symptoms with health care utilization in sexual minority and heterosexual colorectal cancer survivors.
Methods
Four hundred eighteen colorectal cancer survivors who were in remission an average of 3 years after their diagnosis were surveyed about their non-emergency health care visits during the preceding 3 months. Survivors reported whether they had experienced any of 21 symptoms common among colorectal cancer survivors in the past week. The relation between having had two or more health care visits in the preceding 3 months and symptoms experienced was assessed using logistic regression, controlling for cancer registry, sexual orientation, sex, age, race/ethnicity, income, and comorbidities.
Results
Of the survivors, 12% reported no symptoms, while 12% reported six or more symptoms. Sexual minority survivors reported significantly more weight concerns and more health-related and general anxiety as well as worse body image than heterosexual survivors. Frequent worrying about weight and experiencing sore skin around the anal area or stoma were the two symptoms that significantly contributed towards explaining survivors’ increased health care utilization.
Conclusion
Weight concerns, which are more common among the heaviest survivors, may prompt survivors to seek help from health care providers, which may lead to more frequent visits. On the other hand, some symptoms, despite their prevalence, had no relationship with the frequency of health care visits, raising questions about whether survivors share these concerns with providers.
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References
Mariotto AB, Enewold L, Zhao J, Zeruto CA, Yabroff KR (2020) Medical care costs associated with cancer survivorship in the United States. Cancer Epidemiol Biomark Prev 29(7):1304–1312
Alfano CM, Leach CR, Smith TG, Miller KD, Alcaraz KI, Cannady RS, Wender RC, Brawley OW (2019) Equitably improving outcomes for cancer survivors and supporting caregivers: a blueprint for care delivery, research, education, and policy. CA Cancer J Clin 69(1):35–49
Yabroff KR, Gansler T, Wender RC, Cullen KJ, Brawley OW (2019) Minimizing the burden of cancer in the United States: goals for a high-performing health care system. CA Cancer J Clin 69(3):166–183
Chavan PP, Kedia SK, Yu X (2020) Impact of physical and functional limitations on health care utilization in older cancer survivors: a medicare current beneficiary survey. J Aging Health 32(9):987–997
Otto AK, Soriano EC, Siegel SD, LoSavio ST, Laurenceau JP (2018) Assessing the relationship between fear of cancer recurrence and health care utilization in early-stage breast cancer survivors. J Cancer Surviv 12(6):775–785
Cheruvu VK, Oancea SC (2016) Current depression as a potential barrier to health care utilization in adult cancer survivors. Cancer Epidemiol 44:132–137
Nipp RD, El-Jawahri A, Moran SM et al (2017) The relationship between physical and psychological symptoms and health care utilization in hospitalized patients with advanced cancer. Cancer. 123(23):4720–4727
Johansson BB, Holmberg L, Berglund IG, Sjödén PO, Glimelius BL (2004) Determinants of cancer patients’ utilization of hospital care within two years after diagnosis. Acta Oncol 43(6):536–544
Boehmer U, Gereige J, Winter M, Ozonoff A (2019) Cancer survivors’ access to care and quality of life: do sexual minorities fare worse than heterosexuals? Cancer. 125(9):3079–3085
Boehmer U, Miao X, Ozonoff A (2012) Health behaviors of cancer survivors of different sexual orientations. Cancer Causes Control 23(9):1489–1496
Boehmer U, Glickman M, Winter M, Clark MA (2013) Long-term breast cancer survivors’ symptoms and morbidity: differences by sexual orientation? J Cancer Surviv 7(2):203–210
Dibble SL, Roberts SA (2002) A comparison of breast cancer diagnosis and treatment between lesbian and heterosexual women. J Gay Lesbian Med Assoc 6(1):9–17
Kent EE, Mitchell SA, Oakley-Girvan I, Arora NK (2014) The importance of symptom surveillance during follow-up care of leukemia, bladder, and colorectal cancer survivors. Support Care Cancer 22(1):163–172
O'Gorman C, Stack J, O'Ceilleachair A et al (2018) Colorectal cancer survivors: an investigation of symptom burden and influencing factors. BMC Cancer 18(1):1022
Bailey CE, Tran Cao HS, Hu CY et al (2015) Functional deficits and symptoms of long-term survivors of colorectal cancer treated by multimodality therapy differ by age at diagnosis. J Gastrointest Surg 19(1):180–188 discussion 188
Whistance RN, Conroy T, Chie W, Costantini A, Sezer O, Koller M, Johnson CD, Pilkington SA, Arraras J, Ben-Josef E, Pullyblank AM, Fayers P, Blazeby JM, European Organisation for the Research and Treatment of Cancer Quality of Life Group (2009) Clinical and psychometric validation of the EORTC QLQ-CR29 questionnaire module to assess health-related quality of life in patients with colorectal cancer. Eur J Cancer 45(17):3017–3026
Naik AD, Uy N, Anaya DA, Moye J (2015) The effects of age, education, and treatment on physical, sexual and body concern symptoms among multimorbid, colorectal cancer survivors. J Geriatr Oncol 6(4):299–306
Zigmond AS, Snaith RP (1983) The Hospital Anxiety and Depression scale. Acta Psychiatr Scand 67:361–370
Bjelland I, Dahl AA, Haug TT, Neckelmann D (2002) The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res 52(2):69–77
Feldman JM, Waterman PD, Coull BA, Krieger N (2015) Spatial social polarisation: using the Index of Concentration at the Extremes jointly for income and race/ethnicity to analyse risk of hypertension. J Epidemiol Community Health 69(12):1199–1207
Krieger N, Waterman PD, Spasojevic J, Li W, Maduro G, Van Wye G (2016) Public health monitoring of privilege and deprivation with the Index of Concentration at the Extremes. Am J Public Health 106(2):256–263
Chaudhry S, Jin L, Meltzer D (2005) Use of a self-report-generated Charlson Comorbidity Index for predicting mortality. Med Care 43(6):607–615
van Zutphen M, Geelen A, Boshuizen HC, Winkels RM, Geijsen AJMR, Wesselink E, Snellen M, Kok DE, de Wilt JHW, van de Meeberg PC, Kouwenhoven EA, van Halteren HK, Spillenaar Bilgen EJ, Kampman E, van Duijnhoven FJB (2019) Pre-to-post diagnosis weight trajectories in colorectal cancer patients with non-metastatic disease. Support Care Cancer 27(4):1541–1549
Gorber SC, Tremblay M, Moher D, Gorber B (2007) A comparison of direct vs. self-report measures for assessing height, weight and body mass index: a systematic review. Obes Rev 8(4):307–326
Walling AM, Weeks JC, Kahn KL, Tisnado D, Keating NL, Dy SM, Arora NK, Mack JW, Pantoja PM, Malin JL (2015) Symptom prevalence in lung and colorectal cancer patients. J Pain Symptom Manag 49(2):192–202
Stulz A, Lamore K, Montalescot L, Favez N, Flahault C (2020) Sexual health in colon cancer patients: a systematic review. Psycho-oncology. 29(7):1095–1104
Donovan KA, Thompson LM, Hoffe SE (2010) Sexual function in colorectal cancer survivors. Cancer Control 17(1):44–51
Salvadalena G (2008) Incidence of complications of the stoma and peristomal skin among individuals with colostomy, ileostomy, and urostomy: a systematic review. J Wound Ostomy Continence Nurs 35(6):596–609
Nybaek H, Knudsen D, Laursen T, Karlsmark T, Jemec G (2010) Quality of life assessment among patients with peristomal skin disease. Eur J Gastroenterol Hepatol 22(2):139–143
Averyt JC, Nishimoto PW (2014) Addressing sexual dysfunction in colorectal cancer survivorship care. J Gastrointest Oncol 5(5):388–394
Albers LF, Palacios LAG, Pelger RCM, Elzevier HW (2020) Can the provision of sexual healthcare for oncology patients be improved? A literature review of educational interventions for healthcare professionals. J Cancer Surviv 14(6):858–866
Griggs J, Maingi S, Blinder V et al (2017) American Society of Clinical Oncology position statement: strategies for reducing cancer health disparities among sexual and gender minority populations. J Clin Oncol 35(19):JCO2016720441
Funding
This work was supported by the National Cancer Institute at the National Institutes of Health (1R01CA181392-01A1). The collection of cancer incidence data in Georgia was supported by contract HHSN261201800003I, Task Order HHSN26100001 from the NCI, and cooperative agreement 5NU58DP006352-03-00 from the Centers for Disease Control and Prevention (CDC).
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UB conceived the study and led the writing. AO guided the statistical analysis. MW and FB performed the analysis. MAC, KCW, and MW were heavily involved in the facilitation of the data collection. All authors helped with the interpretation of the results and edited and approved the final manuscript.
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All aspects of the study were approved by the Institutional Review Boards of Boston University and the respective cancer registries from which we obtained colorectal cancer cases for this study.
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All participants were consented as explained in our IRB applications.
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Boehmer, U., Potter, J., Clark, M.A. et al. Assessing the relationship between symptoms and health care utilization in colorectal cancer survivors of different sexual orientations. Support Care Cancer 29, 5821–5830 (2021). https://doi.org/10.1007/s00520-021-06157-1
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DOI: https://doi.org/10.1007/s00520-021-06157-1