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

Portz, Jennifer Dickman; Kutner, Jean S.; Blatchford, Patrick J.; Ritchie, Christine S.

doi:10.1111/jgs.15045

Cited by 42 publications

(36 citation statements)

References 35 publications

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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: 71%

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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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Section: Discussioncontrasting

confidence: 79%

Section: Discussioncontrasting

confidence: 71%

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

Mazor

Paul

Chesney

et al. 2019

Cancer

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“…The results of some studies support the idea that symptom severity and the presence of geriatric syndromes (e.g. falls, urinary incontinence, pain) – independent of multimorbidity – are associated with the development of functional impairment and disability . In fact, multimorbidity may be a mediator between pathophysiological processes and negative health outcomes such as impaired physical function .…”

Section: Interplay Between Multimorbidity and Functionmentioning

confidence: 66%

Multimorbidity and functional impairment–bidirectional interplay, synergistic effects and common pathways

et al. 2018

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Calderón-Larrañaga A, Vetrano DL, Ferrucci L, Mercer SW, Marengoni A, Onder G, Eriksdotter M, Fratiglioni L. (Karolinska Institutet-Stockholm University, Stockholm, Sweden; Catholic University of the Sacred Heart, Rome, Italy; National Institutes of Health, Baltimore, MD, USA; University of Glasgow, Glasgow, UK; University of Brescia, Brescia, Italy; Karolinska Institutet, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden; Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy). Multimorbidity and functional impairment– bidirectional interplay, synergistic effects and common pathways. This review discusses the interplay between multimorbidity (i.e. co-occurrence of more than one chronic health condition in an individual) and functional impairment (i.e. limitations in mobility, strength or cognition that may eventually hamper a person’s ability to perform everyday tasks). On the one hand, diseases belonging to common patterns of multimorbidity may interact, curtailing compensatory mechanisms and resulting in physical and cognitive decline. On the other hand, physical and cognitive impairment impact the severity and burden of multimorbidity, contributing to the establishment of a vicious circle. The circle may be further exacerbated by people’s reduced ability to cope with treatment and care burden and physicians’ fragmented view of health problems, which cause suboptimal use of health services and reduced quality of life and survival. Thus, the synergistic effects of medical diagnoses and functional status in adults, particularly older adults, emerge as central to assessing their health and care needs. Furthermore, common pathways seem to underlie multimorbidity, functional impairment and their interplay. For example, older age, obesity, involuntary weight loss and sedentarism can accelerate damage accumulation in organs and physiological systems by fostering inflammatory status. Inappropriate use or overuse of specific medications and drug–drug and drug–disease interactions also contribute to the bidirectional association between multimorbidity and functional impairment. Additionally, psychosocial factors such as low socioeconomic status and the direct or indirect effects of negative life events, weak social networks and an external locus of control may underlie the complex interactions between multimorbidity, functional decline and negative outcomes. Identifying modifiable risk factors and pathways common to multimorbidity and functional impairment could aid in the design of interventions to delay, prevent or alleviate age-related health deterioration; this review provides an overview of knowledge gaps and future directions.

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“…First, it is difficult to attribute symptoms to cancer; however, having a control group allowed us to make a valid inference regarding differences in matched cancer versus noncancer populations. An additively scored symptom checklist approach like ours has been used in similar studies with good concurrent validity . Second, we did not measure all possible symptoms, such as lymphedema, posttramautic stress disorder, sexual dysfunction, or financial stress; these are important to consider in future research.…”

Section: Discussionmentioning

confidence: 99%

Symptom burden among older breast cancer survivors: The Thinking and Living With Cancer (TLC) study

Mandelblatt

Zhai

Ahn

et al. 2019

Cancer

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Background Little is known about longitudinal symptom burden, its consequences for well‐being, and whether lifestyle moderates the burden in older survivors. Methods The authors report on 36‐month data from survivors aged ≥60 years with newly diagnosed, nonmetastatic breast cancer and noncancer controls recruited from August 2010 through June 2016. Symptom burden was measured as the sum of self‐reported symptoms/diseases as follows: pain (yes or no), fatigue (on the Functional Assessment of Cancer Therapy [FACT]‐Fatigue scale), cognitive (on the FACT‐Cognitive scale), sleep problems (yes or no), depression (on the Center for Epidemiologic Studies Depression scale), anxiety (on the State‐Trait Anxiety Inventory), and cardiac problems and neuropathy (yes or no). Well‐being was measured using the FACT‐General scale, with scores from 0 to 100. Lifestyle included smoking, alcohol use, body mass index, physical activity, and leisure activities. Mixed models assessed relations between treatment group (chemotherapy with or without hormone therapy, hormone therapy only, and controls) and symptom burden, lifestyle, and covariates. Separate models tested the effects of fluctuations in symptom burden and lifestyle on function. Results All groups reported high baseline symptoms, and levels remained high over time; differences between survivors and controls were most notable for cognitive and sleep problems, anxiety, and neuropathy. The adjusted burden score was highest among chemotherapy‐exposed survivors, followed by hormone therapy‐exposed survivors versus controls (P < .001). The burden score was related to physical, emotional, and functional well‐being (eg, survivors with lower vs higher burden scores had 12.4‐point higher physical well‐being scores). The composite lifestyle score was not related to symptom burden or well‐being, but physical activity was significantly associated with each outcome (P < .005). Conclusions Cancer and its treatments are associated with a higher level of actionable symptoms and greater loss of well‐being over time in older breast cancer survivors than in comparable noncancer populations, suggesting the need for surveillance and opportunities for intervention.

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

Cited by 42 publications

References 35 publications

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

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

Multimorbidity and functional impairment–bidirectional interplay, synergistic effects and common pathways

Symptom burden among older breast cancer survivors: The Thinking and Living With Cancer (TLC) study

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