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Assessing the relationship between symptoms and health care utilization in colorectal cancer survivors of different sexual orientations

Supportive Care in Cancer volume 29, pages 5821–5830 (2021)Cite this article

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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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).

Author information

Author notes

  1. Melissa A. Clark

    Present address: Brown University School of Public Health, Providence, RI, USA

Affiliations

  1. Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center, Boston, MA, 02118, USA

    Ulrike Boehmer

  2. Harvard Medical School, Boston, MA, USA

    Jennifer Potter

  3. Beth Israel Deaconess Medical Center, Boston, MA, USA

    Jennifer Potter

  4. The Fenway Institute, Boston, MA, USA

    Jennifer Potter

  5. University of Massachusetts Medical School, Shrewsbury, MA, USA

    Melissa A. Clark

  6. Precision Vaccines Program, Boston Children’s Hospital, Boston, MA, USA

    Al Ozonoff

  7. Department of Pediatrics, Harvard Medical School, Boston, MA, USA

    Al Ozonoff

  8. Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA

    Michael Winter & Flora Berklein

  9. Emory University, Rollins School of Public Health, Atlanta, GA, USA

    Kevin C Ward

  10. Section of Hematology Oncology, Boston University School of Medicine, Boston, MA, USA

    Kevan Hartshorn

Authors
  1. Ulrike Boehmer
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  2. Jennifer Potter
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  3. Melissa A. Clark
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  4. Al Ozonoff
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  5. Michael Winter
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  6. Flora Berklein
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  7. Kevin C Ward
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Contributions

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.

Corresponding author

Correspondence to Ulrike Boehmer.

Ethics declarations

Ethics approval

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.

Consent to participate

All participants were consented as explained in our IRB applications.

Consent for publication

Not applicable.

Conflict of interest

The authors declare no competing interests.

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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

Keywords

  • Sexual minorities
  • Oncology
  • Health services
  • Colorectal neoplasms
  • Patient-reported outcomes