Association between patients' perception of the comorbidity burden and symptoms in outpatients with common solid tumors

Ritchie, Christine S.; Zhao, Fengmin; Patel, Kanan; Manola, Judith; Kvale, Elizabeth; Snyder, Claire; Fisch, Michael J.

doi:10.1002/cncr.30801

Cited by 21 publications

(20 citation statements)

References 27 publications

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“…Although multimorbidity was associated with higher symptom burden, cancer was not. Severe and persistent symptoms have previously been linked to multimorbidity in community‐dwelling older adults, and greater symptom burden has been associated with multimorbidity in individuals with cancer . These findings, in concert with those of previous studies, suggest that, in many instances, noncancer diagnoses drive symptom burden whether the individual has cancer or not.…”

Section: Discussionsupporting

confidence: 64%

“…Previous studies suggest that individuals with life‐limiting illness have high symptom burden, particularly pain, regardless of diagnosis . Multimorbidity is also common in individuals with cancer, and clinicians have difficultly addressing these individuals’ symptoms . Providers of cancer care may not consider that symptoms might be emanating from conditions other than cancer.…”

Section: Discussionmentioning

confidence: 99%

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High Symptom Burden and Low Functional Status in the Setting of Multimorbidity

Portz

Kutner

Blatchford

et al. 2017

J American Geriatrics Society

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Objective To enhance understanding of the relationship between multimorbidity, symptom burden, and functional status among patients with life-limiting illness. Design Secondary analysis of baseline data from a randomized clinical trial conducted in the Palliative Care Research Cooperative Group (PCRC). Group differences were tested with a t-test; multivariate regression analysis was used to determine effect of multiple variables on functional status and symptom burden. Participants Adults (N=381) recruited from 15 Palliative Care Research Cooperation sites who participated in the parent statin-discontinuation clinical trial were included in the analysis. Inclusion criteria for the trial was: diagnosis of a life-limiting illness, statin use for ≥ 3 months, life expectancy >1 month, and declining functional status. Measurements Cancer diagnosis: solid organ and hematologic malignancies; Multimorbidity: >2 on Charlson Comorbidity Index (CCI); High symptom burden: a) number of symptoms with a severity score >4, and b) any score > 7 on Edmonton Symptom Assessment Scale (ESAS); Functional status: Australia-modified Karnofsky Performance Scale (AKPS). Results Fifty-one percent had a primary diagnosis of cancer, mean age 74.1 years (SD 11.6). Participants had multiple comorbid illnesses (CCI=4.9, SD=2.8), multiple symptoms (ESAS=27.2, SD=15.9) and reduced functional status (AKPS=53, SD=13). In both univariate and multivariate analyses, multimorbidity was associated with greater symptom burden (4.2 vs. 3.1 moderate or severe symptoms (t=−3.2, p=.002); 12% vs. 6% with severe symptoms (t=−3.7, p<0.001), while cancer diagnosis was not. In both univariate and multivariate analyses, higher symptom burden was associated with lower functional status (F = 11.6, p<0.001) while multimorbidity was not. Conclusion Symptoms cannot be attributed solely to a diagnosis of cancer. The association between symptom burden and functional status underscores the importance of clinical attention to symptoms in patients with multimorbidity.

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Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

High Symptom Burden and Low Functional Status in the Setting of Multimorbidity

Portz

Kutner

Blatchford

et al. 2017

J American Geriatrics Society

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“…A growing body of evidence has suggested that lower functional status and/or a higher level of comorbidity are associated with a higher symptom burden . However, in the current study, the relative contribution of lower functional status and higher comorbidity to a survivor's symptom burden was much smaller than the effects of stress (ie, 3.0% and 0.9%, respectively).…”

Section: Discussioncontrasting

confidence: 79%

“…A growing body of evidence has suggested that lower functional status and/or a higher level of comorbidity are associated with a higher symptom burden. 33,[46][47][48] However, in the current study, the relative contribution of lower functional status and higher comorbidity to a survivor's symptom burden was much smaller than the effects of stress (ie, 3.0% and 0.9%, respectively). Given the cross-sectional nature of the current study, additional research is warranted to evaluate the longitudinal relationships between changes in symptom burden, levels of comorbidity, and functional status among cancer survivors.…”

Section: Discussioncontrasting

confidence: 70%

Perceived stress is associated with a higher symptom burden in cancer survivors

Mazor

Paul

Chesney

et al. 2019

Cancer

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Background Although multiple co‐occurring symptoms are a significant problem for cancer survivors, to the authors' knowledge little is known regarding the phenotypic characteristics associated with a higher symptom burden. The objectives of the current study were to evaluate the occurrence, severity, and distress associated with 32 symptoms and examine the phenotypic and stress characteristics associated with a higher symptom burden. Methods A total of 623 cancer survivors completed a demographic questionnaire, as well as measures of functional status, comorbidity, and global (Perceived Stress Scale) and cancer‐related (Impact of Event Scale–Revised) stress. The Memorial Symptom Assessment Scale was used to evaluate symptom burden. Multiple linear regression analysis was used to determine the phenotypic characteristics associated with a higher symptom burden. Results The mean number of symptoms was 9.1 (±5.2). The most common, severe, and distressing symptoms were lack of energy, problems with sexual interest/activity, and hair loss, respectively. Poorer functional status, a higher level of comorbidity, and a history of smoking as well as higher Perceived Stress Scale and Impact of Event Scale–Revised scores were associated with a higher symptom burden. The overall model explained approximately 45.6% of the variance in symptom burden. Conclusions Although cancer survivors report a high number of co‐occurring symptoms of moderate severity and distress, in the current study, no disease or treatment characteristics were found to be associated with a higher symptom burden. Clinicians need to assess for general and disease‐specific stressors and provide referrals for stress management interventions. Future studies need to examine the longitudinal relationships among symptom burden, functional status, and level of comorbidity, as well as the mechanisms that underlie the associations between stress and symptom burden.

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“…Clinical variables such as these appear to impact medication adherence and response to therapy differently from physician adherence/adherence to medical visits. The findings of the current study align with the belief that clinical variables such as the number of comorbid conditions, obesity, or other characteristics may not suffice to predict physician perception or behavior when caring for patients with cancer …”

Section: Discussionsupporting

confidence: 78%

Molecular monitoring of therapeutic milestones and clinical outcomes in patients with chronic myeloid leukemia

Klil-Drori

Yin

Azoulay

et al. 2018

Cancer

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Background In the current study, the authors determined whether adhering to molecular monitoring guidelines in patients with chronic myeloid leukemia (CML) is associated with major molecular response (MMR) and assessed barriers to adherent monitoring. Methods Newly treated patients with CML from the Quebec province‐wide CML registry from 2005 to 2016 were included. Timely polymerase chain reaction (tPCR) was defined as the molecular assessment of BCR‐ABL1 at the 3‐month, 12‐month, and 18‐month time points from the initiation of tyrosine kinase inhibitor (TKI) therapy. The cohort was analyzed as a nested case‐control study. Cases with a first‐ever MMR (BCR‐ABL1 ≤0.1%, assessed at any time during follow‐up) were matched to up to 5 controls by duration of TKI therapy, volume of patients with CML at the treatment center, year of cohort entry, and age. Odds ratios (ORs) for the performance of tPCR and MMR were adjusted for sex, comorbidities, type of TKI, and other important covariates. Results The cohort included 496 patients. Of 392 MMR events, 67.9% occurred before 18 months. The performance of tPCR was associated with a doubling of the MMR rate (OR, 2.23; 95% confidence interval [95% CI], 1.56‐3.21) and was similar with 1 to 3 tPCRs performed (P = .67). Furthermore, tPCRs at 3 months (OR, 2.77; 95% CI, 1.81‐4.23) and 12 months (OR, 3.00; 95% CI, 1.64‐5.49) were associated with achieving early MMR, whereas tPCRs at 18 months were not (OR, 1.23; 95% CI, 0.80‐1.89). Low‐volume centers were found to have lower adherence to tPCR (OR, 0.60; 95% CI, 0.40‐0.89). Conclusions Timely molecular assessment at 3 months and 12 months appears to benefit patients with CML. Adherence to timely monitoring should be encouraged, especially in low‐volume treatment centers.

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Association between patients' perception of the comorbidity burden and symptoms in outpatients with common solid tumors

Cited by 21 publications

References 27 publications

High Symptom Burden and Low Functional Status in the Setting of Multimorbidity

High Symptom Burden and Low Functional Status in the Setting of Multimorbidity

Perceived stress is associated with a higher symptom burden in cancer survivors

Molecular monitoring of therapeutic milestones and clinical outcomes in patients with chronic myeloid leukemia

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