Supportive Care in Cancer

, Volume 16, Issue 7, pp 791–801 | Cite as

Symptoms and treatment burden associated with cancer treatment: results from a cross-sectional national survey in the U.S.

  • David H. Henry
  • Hema N. Viswanathan
  • Eric P. Elkin
  • Shana Traina
  • Shawn Wade
  • David Cella
Original Article

Abstract

Goals

To examine the prevalence of chemotherapy-or radiotherapy-associated side effects and related treatment burden, and correlates of fatigue and missed work days among cancer patients.

Materials and methods

A cross-sectional survey was conducted using a dual sampling frame of 63,949 cancer patients (35,751 from an online panel and 28,198 from telephone listings) ≥18 years receiving chemotherapy and/or radiotherapy at the time of the survey or during the previous 12 months. Data were collected on cancer type, time since diagnosis, treatment side effects, visits, caregiver burden, missed work days, and sociodemographic characteristics. Data are presented only for patients receiving cancer treatment at the time of the survey.

Main results

Of the 15,532 patients (24%) who responded to the screening questionnaire, 1,572 met the eligibility criteria and 1,569 completed the survey; 814 received chemotherapy and/or radiotherapy at the time of the survey. The most common side effects were fatigue (80%), pain (48%), and nausea/vomiting (48%). Patients spent 4.5 h, on average, per visit to treat side effects. Approximately 43% of the patients were employed; of these, 78% were actively working. Employed patients missed, on average, 18 work days annually for side effect treatment. Females, younger and unemployed patients, and those with higher levels of anxiety and depression experienced more fatigue; patients with a greater number of side effects endured more missed work days.

Conclusions

In addition to the symptomatic experience of side effects, patients reported a considerable time burden for treatment. It is important to consider supportive care strategies that may effectively reduce side effects and their associated treatment burden.

Keywords

Chemotherapy Side effects Fatigue Absenteeism Survey 

References

  1. 1.
    Anderson KO, Giralt SA, Mendoza TR, Brown JO, Neumann JL, Mobley GM, Wang XS, Cleeland CS (2007) Symptom burden in patients undergoing autologous stem-cell transplantation. Bone Marrow Transplant 39:759–766PubMedCrossRefGoogle Scholar
  2. 2.
    Andritsch E, Dietmaier G, Hofmann G, Zloklikovits S, Samonigg H (2007) Global quality of life and its potential predictors in breast cancer patients: an exploratory study. Support Care Cancer 15:21–30PubMedCrossRefGoogle Scholar
  3. 3.
    Andrykowski MA, Schmidt JE, Salsman JM, Beacham AO, Jacobsen PB (2005) Use of a case definition approach to identify cancer-related fatigue in women undergoing adjuvant therapy for breast cancer. J Clin Oncol 23:6613–6622PubMedCrossRefGoogle Scholar
  4. 4.
    Basch E, Iasonos A, McDonough T, Barz A, Culkin A, Kris MG, Scher HI, Schrag D (2006) Patient versus clinician symptom reporting using the National Cancer Institute Common Terminology Criteria for Adverse Events: results of a questionnaire-based study. Lancet Oncol 7:903–909PubMedCrossRefGoogle Scholar
  5. 5.
    Bennett B, Goldstein D, Lloyd A, Davenport T, Hickie I (2004) Fatigue and psychological distress—exploring the relationship in women treated for breast cancer. Eur J Cancer 40:1689–1695PubMedCrossRefGoogle Scholar
  6. 6.
    Berndt E, Kallich J, McDermott A, Xu X, Lee H, Glaspy J (2005) Reductions in anaemia and fatigue are associated with improvements in productivity in cancer patients receiving chemotherapy. PharmacoEconomics 23:505–514PubMedCrossRefGoogle Scholar
  7. 7.
    Bradley CJ, Bednarek HL (2002) Employment patterns of long-term cancer survivors. Psycho-oncology 11:188–198PubMedCrossRefGoogle Scholar
  8. 8.
    Bradley CJ, Oberst K, Schenk M (2006) Absenteeism from work: the experience of employed breast and prostate cancer patients in the months following diagnosis. Psycho-oncology 15:739–747PubMedCrossRefGoogle Scholar
  9. 9.
    Butt Z, Wagner LI, Beaumont JL, Paice JA, Straus JL, Peterman AH, Carro G, Von Roenn JH, Shevrin D, Cella D (2007) Longitudinal screening and management of fatigue, pain, and emotional distress associated with cancer therapy. Support Care Cancer (in press)Google Scholar
  10. 10.
    Carlson LE, Angen M, Cullum J, Goodey E, Koopmans J, Lamont L, MacRae JH, Martin M, Pelletier G, Robinson J, Simpson JS, Speca M, Tillotson L, Bultz BD (2004) High levels of untreated distress and fatigue in cancer patients. Br J Cancer 90:2297–2304PubMedGoogle Scholar
  11. 11.
    Cella D (2002) The effects of anemia and anemia treatment on the quality of life of people with cancer. Oncology 16:125–132PubMedGoogle Scholar
  12. 12.
    Cella D, Eton DT, Lai JS, Peterman AH, Merkel DE (2002) Combining anchor and distribution-based methods to derive minimal clinically important differences on the Functional Assessment of Cancer Therapy (FACT) anemia and fatigue scales. J Pain Symptom Manage 24:547–561PubMedCrossRefGoogle Scholar
  13. 13.
    Cella D, Kallich J, McDermott A, Xu X (2004) The longitudinal relationship of hemoglobin, fatigue and quality of life in anemic cancer patients: results from five randomized clinical trials. Ann Oncol 15:979–986PubMedCrossRefGoogle Scholar
  14. 14.
    Cella D, Lai JS, Chang CH, Peterman A, Slavin M (2002) Fatigue in cancer patients compared with fatigue in the general United States population. Cancer 94:528–538PubMedCrossRefGoogle Scholar
  15. 15.
    Cella D, Peterman A, Passik S, Jacobsen P, Breitbart W (1998) Progress toward guidelines for the management of fatigue. Oncology (Willist Park N Y) 12:369–377Google Scholar
  16. 16.
    Cohen J (1988) Statistical power analysis for the behavioral sciences. Erlbaum, Hillsdale, NJGoogle Scholar
  17. 17.
    Curt GA (2000) The impact of fatigue on patients with cancer: overview of FATIGUE 1 and 2. Oncologist 5(Suppl 2):9–12CrossRefGoogle Scholar
  18. 18.
    Curt GA (2000) Impact of fatigue on quality of life in oncology patients. Semin Hematol 37:14–17PubMedCrossRefGoogle Scholar
  19. 19.
    Curt GA, Breitbart W, Cella D, Groopman JE, Horning SJ, Itri LM, Johnson DH, Miaskowski C, Scherr SL, Portenoy RK, Vogelzang NJ (2000) Impact of cancer-related fatigue on the lives of patients: new findings from the Fatigue Coalition. Oncologist 5:353–360PubMedCrossRefGoogle Scholar
  20. 20.
    Derogatis LR (1993) Brief symptom inventory administration, scoring, and procedures manual. NCS Pearson, MinneapolisGoogle Scholar
  21. 21.
    Derogatis LR, Morrow GR, Fetting J, Penman D, Piasetsky S, Schmale AM, Henrichs M, Carnicke CL Jr (1983) The prevalence of psychiatric disorders among cancer patients. JAMA 249:751–757PubMedCrossRefGoogle Scholar
  22. 22.
    Dillon E, Kelly J (2003) The status of cancer fatigue on the Island of Ireland: AIFC professional and interim patient surveys. Oncologist 8(Suppl 1):22–26PubMedCrossRefGoogle Scholar
  23. 23.
    Fossa SD, Dahl AA, Loge JH (2003) Fatigue, anxiety, and depression in long-term survivors of testicular cancer. J Clin Oncol 21:1249–1254PubMedCrossRefGoogle Scholar
  24. 24.
    Gabrilove JL, Perez EA, Tomita DK, Rossi G, Cleeland CS (2007) Assessing symptom burden using the M. D. Anderson symptom inventory in patients with chemotherapy-induced anemia: results of a multicenter, open-label study (SURPASS) of patients treated with darbepoetin-alpha at a dose of 200 microg every 2 weeks. Cancer 110:1629–1640PubMedCrossRefGoogle Scholar
  25. 25.
    Gapstur RL (2007) Symptom burden: a concept analysis and implications for oncology nurses. Oncol Nurs Forum 34:673–680PubMedCrossRefGoogle Scholar
  26. 26.
    Griffin AM, Butow PN, Coates AS, Childs AM, Ellis PM, Dunn SM, Tattersall MH (1996) On the receiving end. V: patient perceptions of the side effects of cancer chemotherapy in 1993. Ann Oncol 7:189–195PubMedGoogle Scholar
  27. 27.
    Groopman JE, Itri LM (1999) Chemotherapy-induced anemia in adults: incidence and treatment. J Natl Cancer Inst 91:1616–1634PubMedCrossRefGoogle Scholar
  28. 28.
    Haley WE (2003) Family caregivers of elderly patients with cancer: understanding and minimizing the burden of care. J Support Oncol 1:25–29PubMedGoogle Scholar
  29. 29.
    Houts AC, Loh GA, Fortner BV, Kallich JD (2006) Patient and caregiver time burden associated with anaemia treatment in different patient populations. Support Care Cancer 14:1195–1204PubMedCrossRefGoogle Scholar
  30. 30.
    Hwang SS, Chang VT, Kasimis BS (2003) A comparison of three fatigue measures in veterans with cancer. Cancer Investig 21:363–373CrossRefGoogle Scholar
  31. 31.
    Kallich JD, Tchekmedyian NS, Damiano AM, Shi J, Black JT, Erder MH (2002) Psychological outcomes associated with anemia-related fatigue in cancer patients. Oncology (Willist Park N Y) 16:117–124Google Scholar
  32. 32.
    Kessler RC, Greenberg PE, Mickelson KD, Meneades LM, Wang PS (2001) The effects of chronic medical conditions on work loss and work cutback. J Occup Environ Med 43:218–225PubMedCrossRefGoogle Scholar
  33. 33.
    Khalid U, Spiro A, Baldwin C, Sharma B, McGough C, Norman AR, Eisen T, O’Brien ME, Cunningham D, Andreyev HJ (2007) Symptoms and weight loss in patients with gastrointestinal and lung cancer at presentation. Support Care Cancer 15:39–46PubMedCrossRefGoogle Scholar
  34. 34.
    Maliski SL, Kwan L, Orecklin JR, Saigal CS, Litwin MS (2005) Predictors of fatigue after treatment for prostate cancer. Urology 65:101–108PubMedCrossRefGoogle Scholar
  35. 35.
    Meehan KR, Tchekmedyian NS, Smith RE, Kallich J (2006) Resource utilisation and time commitment associated with correction of anaemia in cancer patients using epoetin alfa. Clin Drug Investig 26:593–601PubMedCrossRefGoogle Scholar
  36. 36.
    Mock V (2007) NCCN Guidelines (NCCN practice guidelines in oncology—cancer-related fatigue). Version 2.2007. NCCN Clinical Practice Guidelines in OncologyGoogle Scholar
  37. 37.
    Morrow GR, Shelke AR, Roscoe JA, Hickok JT, Mustian K (2005) Management of cancer-related fatigue. Cancer Investig 23:229–239CrossRefGoogle Scholar
  38. 38.
    National Center for Health Statistics (2007) 2005 NHIS questionnaire—sample adult. In: 2005 NHIS questionnaire. Available at ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Survey_Questionnaires/NHIS/2005/English/
  39. 39.
    Patrick DL, Gagnon DD, Zagari MJ, Mathijs R, Sweetenham J, Epoetin Alfa Study G (2003) Assessing the clinical significance of health-related quality of life (HrQOL) improvements in anaemic cancer patients receiving epoetin alfa. Eur J Cancer 39:335–345PubMedCrossRefGoogle Scholar
  40. 40.
    Prieto JM, Blanch J, Atala J, Carreras E, Rovira M, Cirera E, Gasto C (2006) Clinical factors associated with fatigue in haematologic cancer patients receiving stem-cell transplantation. Eur J Cancer 42:1749–1755PubMedCrossRefGoogle Scholar
  41. 41.
    Redeker NS, Lev EL, Ruggiero J (2000) Insomnia, fatigue, anxiety, depression, and quality of life of cancer patients undergoing chemotherapy. Sch Inq Nurs Pract 14:275–290PubMedGoogle Scholar
  42. 42.
    Skarstein J, Aass N, Fossa SD, Skovlund E, Dahl AA (2000) Anxiety and depression in cancer patients: relation between the hospital anxiety and depression scale and the European organization for research and treatment of cancer core quality of life questionnaire. J Psychosom Res 49:27–34PubMedCrossRefGoogle Scholar
  43. 43.
    Stefanek ME, Derogatis LP, Shaw A (1987) Psychological distress among oncology outpatients. Prevalence and severity as measured with the brief symptom inventory. Psychosomatics 28:530–532PubMedGoogle Scholar
  44. 44.
    Stone P, Richardson A, Ream E, Smith AG, Kerr DJ, Kearney N (2000) Cancer-related fatigue: inevitable, unimportant and untreatable? Results of a multi-centre patient survey. Cancer fatigue forum. Ann Oncol 11:971–975PubMedCrossRefGoogle Scholar
  45. 45.
    Taskila-Abrandt T, Pukkala E, Martikainen R, Karjalainen A, Hietanen P (2005) Employment status of Finnish cancer patients in 1997. Psycho-oncology 14:221–226PubMedCrossRefGoogle Scholar
  46. 46.
    Tauer K, Zhu L, Fortner B (2004) The impact of anemia treatment visits on the patient and their caregiver. Proc Am Soc Clin Oncol 23:753 (Abstract 8114)Google Scholar
  47. 47.
    Tchekmedyian NS, Kallich J, McDermott A, Fayers P, Erder MH (2003) The relationship between psychologic distress and cancer-related fatigue. Cancer 98:198–203PubMedCrossRefGoogle Scholar
  48. 48.
    Teunissen SC, Wesker W, Kruitwagen C, de Haes HC, Voest EE, de Graeff A (2007) Symptom prevalence in patients with incurable cancer: a systematic review. J Pain Symptom Manage 34:94–104PubMedCrossRefGoogle Scholar
  49. 49.
    Tran KT, Stephens MK et al (2006) Impact of chemotherapy-induced anemia on economic and quality of life outcomes in adults with cancer. Blood 108:Abstract 3355Google Scholar
  50. 50.
    Vogelzang NJ, Breitbart W, Cella D, Curt GA, Groopman JE, Horning SJ, Itri LM, Johnson DH, Scherr SL, Portenoy RK, Coalition TF (1997) Patient, caregiver, and oncologist perceptions of cancer-related fatigue: results of a tripart assessment survey. Semin Hematol 34:4–12PubMedGoogle Scholar
  51. 51.
    Yabroff KR, Lawrence WF, Clauser S, Davis WW, Brown ML (2004) Burden of illness in cancer survivors: findings from a population-based national sample. J Natl Cancer Inst 96:1322–1330PubMedCrossRefGoogle Scholar
  52. 52.
    Zabora J, BrintzenhofeSzoc K, Curbow B, Hooker C, Piantadosi S, Zabora J, BrintzenhofeSzoc K, Curbow B, Hooker C, Piantadosi S (2001) The prevalence of psychological distress by cancer site. Psycho-oncology 10:19–28PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • David H. Henry
    • 1
  • Hema N. Viswanathan
    • 2
  • Eric P. Elkin
    • 3
  • Shana Traina
    • 2
  • Shawn Wade
    • 4
  • David Cella
    • 5
  1. 1.Joan Karnell Cancer CenterPennsylvania HospitalPhiladelphiaUSA
  2. 2.Amgen Inc.Thousand OaksUSA
  3. 3.ICON Clinical ResearchSan FranciscoUSA
  4. 4.Harris Interactive Inc.ClaremontUSA
  5. 5.Evanston Northwestern Healthcare, Robert H. Lurie Comprehensive Cancer CenterNorthwestern University Feinberg School of MedicineEvanstonUSA

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