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Impact of symptom burden in post-surgical non-small cell lung cancer survivors

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Abstract

Purpose

Pain, fatigue, dyspnea, and distress are commonly reported cancer-related symptoms, but few studies have examined the effects of multiple concurrent symptoms in longer-term cancer survivors. We examined the impact of varying degrees of symptom burden on health-related quality of life (HRQOL) and performance status in surgically treated non-small cell lung cancer (NSCLC) survivors.

Methods

A sample of 183 NSCLC survivors 1–6 years post-surgical treatment completed questionnaires assessing five specific symptoms (pain, fatigue, dyspnea, depression, and anxiety), HRQOL, and performance status. The number of concurrent clinically significant symptoms was calculated as an indicator of symptom burden.

Results

Most survivors (79.8 %) had some degree of symptom burden, with 30.6 % reporting one clinically significant symptom, 27.9 % reporting two symptoms, and 21.3 % reporting three or more symptoms. Physical HRQOL significantly decreased as the degree of symptom burden increased, but mental HRQOL was only significantly decreased in those with three or more symptoms. Receiver-operating characteristic (ROC) curves showed that having multiple concurrent symptoms (two or more) was most likely associated with limitations in functioning (area under a ROC curve = 0.75, sensitivity = 0.81, specificity = 0.54).

Conclusions

Two or more clinically significant symptoms are identified as the “tipping point” for showing adverse effects on HRQOL and functioning. This highlights the need for incorporating multiple-symptom assessment into routine clinical practice. Comprehensive symptom management remains an important target of intervention for improved post-treatment HRQOL and functioning among lung cancer survivors.

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References

  1. American Cancer Society (2012) Cancer facts & figures 2012. American Cancer Society, Atlanta

    Google Scholar 

  2. Hewitt M, Rowland JH, Yancik R (2003) Cancer survivors in the United States: age, health, and disability. J Gerontol A: Biol Med Sci 58:82–91

    Article  Google Scholar 

  3. National Institute of Health (2002) NIH State-of-the-Science Statement on symptom management in cancer: pain, depression, and fatigue. NIH Consens State Sci Statements 19(4):1–29

    Google Scholar 

  4. Shi Q, Smith TG, Michonski JD, Stein KD, Kaw C, Cleeland CS (2011) Symptom burden in cancer survivors 1 year after diagnosis: a report from the American Cancer Society's Studies of Cancer Survivors. Cancer 117:2779–2790

    Article  PubMed  Google Scholar 

  5. Burkett VS, Cleeland CS (2007) Symptom burden in cancer survivorship. J Cancer Survivorship Res Pract 1:167–175

    Article  Google Scholar 

  6. Cheville AL, Novotny PJ, Sloan JA et al (2011) Fatigue, dyspnea, and cough comprise a persistent symptom cluster up to five years after diagnosis with lung cancer. J Pain Symptom Manag 42:202–212

    Article  Google Scholar 

  7. Eversley R, Estrin D, Dibble S, Wardlaw L, Pedrosa M, Favila-Penney W (2005) Post-treatment symptoms among ethnic minority breast cancer survivors. Oncol Nurs Forum 32:250–256

    Article  PubMed  Google Scholar 

  8. Fu OS, Crew KD, Jacobson JS et al (2009) Ethnicity and persistent symptom burden in breast cancer survivors. J Cancer Survivorship Res Pract 3:241–250

    Article  Google Scholar 

  9. Harrington CB, Hansen JA, Moskowitz M, Todd BL, Feuerstein M (2010) It's not over when it's over: long-term symptoms in cancer survivors–a systematic review. Int J Psychiatry Med 40:163–181

    Article  PubMed  Google Scholar 

  10. Sarna L, Padilla G, Holmes C, Tashkin D, Brecht ML, Evangelista L (2002) Quality of life of long-term survivors of non-small-cell lung cancer. J Clin Oncol Off J Am Soc Clin Oncol 20:2920–2929

    Article  Google Scholar 

  11. Svobodnik A, Yang P, Novotny PJ et al (2004) Quality of life in 650 lung cancer survivors 6 months to 4 years after diagnosis. Mayo Clin Proc Mayo Clin 79:1024–1030

    Article  Google Scholar 

  12. Cheville AL, Novotny PJ, Sloan JA et al (2011) The value of a symptom cluster of fatigue, dyspnea, and cough in predicting clinical outcomes in lung cancer survivors. J Pain Symptom Manag 42:213–221

    Article  Google Scholar 

  13. Cleeland CS (2007) Symptom burden: multiple symptoms and their impact as patient-reported outcomes. J Natl Cancer Inst Monogr 37:16–21

    Article  PubMed  Google Scholar 

  14. Cooley ME, Short TH, Moriarty HJ (2002) Patterns of symptom distress in adults receiving treatment for lung cancer. J Palliat Care 18:150–159

    PubMed  Google Scholar 

  15. Dodd MJ, Cho MH, Cooper BA, Miaskowski C (2010) The effect of symptom clusters on functional status and quality of life in women with breast cancer. Eur J Oncol Nurs Off J Eur Oncol Nurs Soc 14:101–110

    Article  Google Scholar 

  16. Dodd MJ, Miaskowski C, Paul SM (2001) Symptom clusters and their effect on the functional status of patients with cancer. Oncol Nurs Forum 28:465–470

    PubMed  CAS  Google Scholar 

  17. Esther Kim JE, Dodd MJ, Aouizerat BE, Jahan T, Miaskowski C (2009) A review of the prevalence and impact of multiple symptoms in oncology patients. J Pain Symptom Manag 37:715–736

    Article  Google Scholar 

  18. Ferreira KA, Kimura M, Teixeira MJ et al (2008) Impact of cancer-related symptom synergisms on health-related quality of life and performance status. J Pain Symptom Manag 35:604–616

    Article  Google Scholar 

  19. Gift AG, Stommel M, Jablonski A, Given W (2003) A cluster of symptoms over time in patients with lung cancer. Nurs Res 52:393–400

    Article  PubMed  Google Scholar 

  20. Henry DH, Viswanathan HN, Elkin EP, Traina S, Wade S, Cella D (2008) Symptoms and treatment burden associated with cancer treatment: results from a cross-sectional national survey in the U.S. Support Care Cancer Off J Multinatl Assoc Support Care Cancer 16:791–801

    Google Scholar 

  21. Jones JM, Cohen SR, Zimmermann C, Rodin G (2010) Quality of life and symptom burden in cancer patients admitted to an acute palliative care unit. J Palliat Care 26:94–102

    PubMed  Google Scholar 

  22. Kirkova J, Aktas A, Walsh D, Davis MP (2011) Cancer symptom clusters: clinical and research methodology. J Palliat Med 14:1149–1166

    Article  PubMed  Google Scholar 

  23. Miaskowski C, Cooper BA, Paul SM et al (2006) Subgroups of patients with cancer with different symptom experiences and quality-of-life outcomes: a cluster analysis. Oncol Nurs Forum 33:E79–E89

    Article  PubMed  Google Scholar 

  24. Molassiotis A, Wengstrom Y, Kearney N (2010) Symptom cluster patterns during the first year after diagnosis with cancer. J Pain Symptom Manag 39:847–858

    Article  Google Scholar 

  25. Rausch SM, Clark MM, Patten C et al (2010) Relationship between cytokine gene single nucleotide polymorphisms and symptom burden and quality of life in lung cancer survivors. Cancer 116:4103–4113

    Article  PubMed  CAS  Google Scholar 

  26. Wang XS, Shi Q, Williams LA et al (2010) Inflammatory cytokines are associated with the development of symptom burden in patients with NSCLC undergoing concurrent chemoradiation therapy. Brain Behav Immun 24:968–974

    Article  PubMed  CAS  Google Scholar 

  27. Buchanan D, Milroy R, Baker L, Thompson AM, Levack PA (2009) Perceptions of anxiety in lung cancer patients and their support network. Support Care Cancer Off J Multinatl Assoc Support Care Cancer 18:29–36

    Google Scholar 

  28. Institute of Medicine (2005) From cancer patient to cancer survivor: lost in transition. The National Academies, Washington DC

    Google Scholar 

  29. Portenoy RK, Thaler HT, Kornblith AB et al (1994) Symptom prevalence, characteristics and distress in a cancer population. Qual Life Res Int J Qual Life Asp Treat Care Rehab 3:183–189

    Article  CAS  Google Scholar 

  30. Sun V, Ferrell B, Juarez G, Wagman LD, Yen Y, Chung V (2008) Symptom concerns and quality of life in hepatobiliary cancers. Oncol Nurs Forum 35:E45–E52

    Article  PubMed  Google Scholar 

  31. Cleeland CS, Ryan KM (1994) Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med 23:129–138

    CAS  Google Scholar 

  32. Serlin RC, Mendoza TR, Nakamura Y, Edwards KR, Cleeland CS (1995) When is cancer pain mild, moderate or severe? Grading pain severity by its interference with function. Pain 61:277–284

    Article  PubMed  CAS  Google Scholar 

  33. Temel JS, Pirl WF, Lynch TJ (2006) Comprehensive symptom management in patients with advanced-stage non-small-cell lung cancer. Clin Lung Cancer 7:241–249

    Article  PubMed  Google Scholar 

  34. Hung R, Krebs P, Coups EJ et al (2011) Fatigue and functional impairment in early-stage non-small cell lung cancer survivors. J Pain Symptom Manag 41:426–435

    Article  Google Scholar 

  35. Feinstein MB, Krebs P, Coups EJ et al (2010) Current dyspnea among long-term survivors of early-stage non-small cell lung cancer. J Thorac Oncol Off Publ Int Assoc Study Lung Cancer 5:1221–1226

    Google Scholar 

  36. Ostroff JS, Krebs P, Coups EJ et al (2011) Health-related quality of life among early-stage, non-small cell, lung cancer survivors. Lung Cancer 71:103–108

    Article  PubMed  Google Scholar 

  37. Krebs P, Coups EJ, Feinstein MB et al (2012) Health behaviors of early-stage non-small cell lung cancer survivors. J Cancer Survivorship Res Pract 6:37–44

    Article  Google Scholar 

  38. Buist AS, Connett JE, Miller RD, Kanner RE, Owens GR, Voelker HT (1993) Chronic obstructive pulmonary disease early intervention trial (lung health study). Baseline characteristics of randomized participants. Chest 103:1863–1872

    Article  PubMed  CAS  Google Scholar 

  39. Ware JJ, Kosinski M, Gandek B (2000) SF-36 health survey: manual and interpretation guide. QualityMetric, Inc., Lincoln

    Google Scholar 

  40. Mendoza TR, Wang XS, Cleeland CS et al (1999) The rapid assessment of fatigue severity in cancer patients: use of the Brief Fatigue Inventory. Cancer 85:1186–1196

    Article  PubMed  CAS  Google Scholar 

  41. Mahler DA, Weinberg DH, Wells CK, Feinstein AR (1984) The measurement of dyspnea. Contents, interobserver agreement, and physiologic correlates of two new clinical indexes. Chest 85:751–758

    Article  PubMed  CAS  Google Scholar 

  42. Eakin EG, Sassi-Dambron DE, Ries AL, Kaplan RM (1995) Reliability and validity of dyspnea measures in patients with obstructive lung disease. Int J Behav Med 2:118–134

    Article  PubMed  CAS  Google Scholar 

  43. Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370

    Article  PubMed  CAS  Google Scholar 

  44. Zweig MH, Campbell G (1993) Receiver-operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine. Clin Chem 39:561–577

    PubMed  CAS  Google Scholar 

  45. Cella D, Nichol MB, Eton D, Nelson JB, Mulani P (2009) Estimating clinically meaningful changes for the Functional Assessment of Cancer Therapy–Prostate: results from a clinical trial of patients with metastatic hormone-refractory prostate cancer. Value Health J Int Soc Pharmacoecon Outcomes Res 12:124–129

    Article  Google Scholar 

Download references

Acknowledgments

This project was supported in part by the Byrne Foundation (study design and data collection), grant T32CA009461 from the National Cancer Institute (data analysis, interpretation, and presentation), and P30 CA08748 (Behavioral Research Methods Core). We thank Melissa Ozim and Syncia Sabain for their assistance with data collection and management, and the study participants for their valued contribution.

Conflict of interest

Funding sponsors were not involved in the conduct of the study or development of the submission. Manuscript authors had full control of all primary data and would be happy to comply with allowing the journal to review study data if requested. Preliminary findings were presented as a poster at the 33rd Annual Society for Behavioral Medicine Conference held in New Orleans, LA, USA from 11–14 April 2012.

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Authors and Affiliations

  1. School of Medicine, University of Pittsburgh, 5115 Centre Ave, Suite 140, Pittsburgh, PA, USA

    Amy E. Lowery

  2. Department of Psychiatry & Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Amy E. Lowery, Jack E. Burkhalter & Jamie S. Ostroff

  3. Department of Population Health, NYU Langone Medical Center, New York, NY, USA

    Paul Krebs

  4. VA New York Harbor Healthcare System, New York, NY, USA

    Paul Krebs

  5. Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA

    Elliot J. Coups

  6. Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA

    Elliot J. Coups

  7. Department of Health Education and Behavioral Science, Rutgers School of Public Health, Piscataway, NJ, USA

    Elliot J. Coups

  8. Rutgers, The State University of New Jersey, New Brunswick, NJ, USA

    Elliot J. Coups

  9. Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Marc B. Feinstein

  10. Department of Thoracic Surgery, Hackensack University Medical Center, Hackensack, NJ, USA

    Bernard J. Park

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  1. Amy E. Lowery
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  2. Paul Krebs
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  7. Jamie S. Ostroff
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Correspondence to Amy E. Lowery.

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Lowery, A.E., Krebs, P., Coups, E.J. et al. Impact of symptom burden in post-surgical non-small cell lung cancer survivors. Support Care Cancer 22, 173–180 (2014). https://doi.org/10.1007/s00520-013-1968-3

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  • DOI: https://doi.org/10.1007/s00520-013-1968-3

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