Self-reported Symptoms Among Cancer Survivors in the Women's Health Initiative (WHI) Life and Longevity After Cancer (LILAC) Cohort

Overview

Journal J Cancer Surviv

Specialty Oncology

Date 2022 Mar 22

PMID 35314957

Authors

Brittany M Bernardo

Michael L Pennell

Michelle J Naughton

Nils Patrik Brodin

Marian L Neuhouser

Rowan T Chlebowski

Electra D Paskett

Affiliations

Soon will be listed here.

Abstract

Purpose: Due to cancer survivors living longer and morbidity associated with cancer treatments, it is necessary to understand symptoms experienced by cancer survivors. This study will analyze the symptom burden among a large cohort of survivors across multiple cancer sites.

Methods: Data from the Women's Health Initiative (WHI) Life and Longevity After Cancer (LILAC) study were used to examine the symptom burden of older cancer survivors. Poisson regression with robust standard errors was utilized to determine differences in symptoms by cancer site, treatment, and other covariates.

Results: The most frequently reported symptoms among cancer survivors were fatigue (15.8%) and feeling sad or depressed (14.1%). Multivariable analyses indicated that more symptoms were reported among survivors who were younger (p = 0.002), divorced or separated (p = 0.03), and had a combination of public and private insurance (p = 0.01). Survivors who received chemotherapy (p < 0.001), radiation (p = 0.01), or hormone therapy (p = 0.02) reported more symptoms than survivors who did not receive these treatments. Survivors diagnosed with cancer < 5 years ago reported fewer symptoms than longer-term survivors, particularly those diagnosed > 10 years ago (p = 0.02).

Conclusions: Results indicate that common physical and psychological symptoms are reported across cancer types. Cancer survivors diagnosed with cancer 10 or more years ago reported more symptoms than those recently diagnosed. This suggests that symptoms may remain a problem for some survivors decades after their diagnosis.

Implications For Cancer Survivors: Future research should focus on implementing active surveillance of cancer survivors. Healthcare providers and those who care for cancer survivors should understand that the symptom burden associated with cancer may persist even decades following diagnosis.

Citing Articles

Factors associated with long-term gastrointestinal symptoms in colorectal cancer survivors in the women's health initiatives (WHI study).

Han C, Reding K, Kalady M, Yung R, Greenlee H, Paskett E PLoS One. 2023; 18(5):e0286058.

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Bayesian semiparametric joint modeling of a count outcome and inconveniently timed longitudinal predictors.

Lim W, Pennell M, Naughton M, Paskett E Stat Methods Med Res. 2023; 32(5):853-867.

PMID: 36855822 PMC: 10725663. DOI: 10.1177/09622802231154325.

References

Haisfield-Wolfe M, McGuire D, Soeken K, Geiger-Brown J, De Forge B . Prevalence and correlates of depression among patients with head and neck cancer: a systematic review of implications for research. Oncol Nurs Forum. 2009; 36(3):E107-25. DOI: 10.1188/09.ONF.E107-E125. View

Karlson C, Alberts N, Liu W, Brinkman T, Annett R, Mulrooney D . Longitudinal pain and pain interference in long-term survivors of childhood cancer: A report from the Childhood Cancer Survivor Study. Cancer. 2020; 126(12):2915-2923. PMC: 7245551. DOI: 10.1002/cncr.32853. View

Kenyon M, Mayer D, Owens A . Late and long-term effects of breast cancer treatment and surveillance management for the general practitioner. J Obstet Gynecol Neonatal Nurs. 2014; 43(3):382-98. DOI: 10.1111/1552-6909.12300. View

Oldenmenger W, de Raaf P, de Klerk C, van der Rijt C . Cut points on 0-10 numeric rating scales for symptoms included in the Edmonton Symptom Assessment Scale in cancer patients: a systematic review. J Pain Symptom Manage. 2012; 45(6):1083-93. DOI: 10.1016/j.jpainsymman.2012.06.007. View

van Buuren S . Multiple imputation of discrete and continuous data by fully conditional specification. Stat Methods Med Res. 2007; 16(3):219-42. DOI: 10.1177/0962280206074463. View

Harrington C, Hansen J, Moskowitz M, Todd B, Feuerstein M . It's not over when it's over: long-term symptoms in cancer survivors--a systematic review. Int J Psychiatry Med. 2010; 40(2):163-81. DOI: 10.2190/PM.40.2.c. View

Mao J, Armstrong K, Bowman M, Xie S, Kadakia R, Farrar J . Symptom burden among cancer survivors: impact of age and comorbidity. J Am Board Fam Med. 2007; 20(5):434-43. DOI: 10.3122/jabfm.2007.05.060225. View

Mustafa Ali M, Moeller M, Rybicki L, Moore H . Long-term peripheral neuropathy symptoms in breast cancer survivors. Breast Cancer Res Treat. 2017; 166(2):519-526. DOI: 10.1007/s10549-017-4437-8. View

Gallaway M, Townsend J, Shelby D, Puckett M . Pain Among Cancer Survivors. Prev Chronic Dis. 2020; 17:E54. PMC: 7367076. DOI: 10.5888/pcd17.190367. View

10.

Shahrokni A, Wu A, Carter J, Lichtman S . Long-term Toxicity of Cancer Treatment in Older Patients. Clin Geriatr Med. 2015; 32(1):63-80. PMC: 4839483. DOI: 10.1016/j.cger.2015.08.005. View

11.

Matthews H, Semper H . 'Dropped from the system': the experiences and challenges of long-term breast cancer survivors. J Adv Nurs. 2016; 73(6):1355-1365. DOI: 10.1111/jan.13237. View

12.

Schultz P, Klein M, Beck M, Stava C, Sellin R . Breast cancer: relationship between menopausal symptoms, physiologic health effects of cancer treatment and physical constraints on quality of life in long-term survivors. J Clin Nurs. 2005; 14(2):204-11. DOI: 10.1111/j.1365-2702.2004.01030.x. View

13.

Gegechkori N, Haines L, Lin J . Long-Term and Latent Side Effects of Specific Cancer Types. Med Clin North Am. 2017; 101(6):1053-1073. PMC: 5777532. DOI: 10.1016/j.mcna.2017.06.003. View

14.

Lovelace D, McDaniel L, Golden D . Long-Term Effects of Breast Cancer Surgery, Treatment, and Survivor Care. J Midwifery Womens Health. 2019; 64(6):713-724. DOI: 10.1111/jmwh.13012. View

15.

Clark C, Fino N, Liang J, Hiller D, Bohl J . Depressive symptoms in older long-term colorectal cancer survivors: a population-based analysis using the SEER-Medicare healthcare outcomes survey. Support Care Cancer. 2016; 24(9):3907-14. PMC: 7064812. DOI: 10.1007/s00520-016-3227-x. View

16.

Maass S, Boerman L, Brandenbarg D, Verhaak P, Maduro J, de Bock G . Symptoms in long-term breast cancer survivors: A cross-sectional study in primary care. Breast. 2020; 54:133-138. PMC: 7554212. DOI: 10.1016/j.breast.2020.09.013. View

17.

Halpern M, Brawley O . Insurance status, health equity, and the cancer care continuum. Cancer. 2016; 122(20):3106-3109. DOI: 10.1002/cncr.30158. View

18.

Horick N, Muzikansky A, Gutierrez H, Boyd K, Finkelstein D . Physical symptoms in long-term survivors of rare cancer. J Cancer Surviv. 2018; 12(6):835-842. PMC: 6503956. DOI: 10.1007/s11764-018-0721-9. View

19.

Klemp J, Myers J, Fabian C, Kimler B, Khan Q, Sereika S . Cognitive functioning and quality of life following chemotherapy in pre- and peri-menopausal women with breast cancer. Support Care Cancer. 2017; 26(2):575-583. PMC: 5754254. DOI: 10.1007/s00520-017-3869-3. View

20.

Lathan C, Cronin A, Tucker-Seeley R, Zafar S, Ayanian J, Schrag D . Association of Financial Strain With Symptom Burden and Quality of Life for Patients With Lung or Colorectal Cancer. J Clin Oncol. 2016; 34(15):1732-40. PMC: 4966336. DOI: 10.1200/JCO.2015.63.2232. View