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Cited by 83Cancer survivorship and careChildhood Cancer Survivors' Quality of LifeLong-Term Effects of COVID-19

All’s Well That Ends Well? Quality of Life and Physical Symptom Clusters in Long-Term Cancer Survivors Across Cancer Types

Open access
Zucca, Alison C., Boyes, Allison W., Linden, Wolfgang, Girgis, Afaf·2012·Journal of Pain and Symptom Management
DOI 10.1016/j.jpainsymman.2011.04.023
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Abstract

Context Little is known about the presentation of multiple concurrent symptoms (symptom clusters) in long-term cancer survivors, with few studies adequately powered to compare quality of life (QoL) and symptom presentation by cancer type.Objectives This research aimed to 1) assess patient-reported QoL and 2) identify clusters of cancer-related physical symptoms by cancer type among long-term breast, prostate, colorectal, and melanoma cancer survivors.Methods A population-based cross-sectional sample of 863 adult cancer survivors five to six years post-diagnosis completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), assessing global QoL and frequency of presentation of cancer-related physical symptoms.Results Long-term survivors reported higher levels of global QoL than 1) the general population (age-adjusted mean=79.4 vs. 71.1, small clinical difference) and 2) cancer patients early in the care trajectory (age-adjusted mean=77.1 vs. 61.3, moderate clinical difference). The majority (71%) did not report any cancer-related physical symptoms; 18% reported multiple (two or more) symptoms in the past month. Factor analysis found that cognitive functioning, fatigue, insomnia, pain, dyspnea, appetite loss, constipation, diarrhea, nausea, and vomiting formed a cluster (α=0.48). No symptom clusters were identified that were specific to just one cancer type. However, individual symptoms (including diarrhea, pain, constipation, and insomnia) modestly discriminated between cancer types.Conclusion Contrary to expectations, no symptom clusters specific to one type of cancer were identified and survivors reported few cancer-related symptoms and high QoL. These results convey a strong "good news" message, providing health professionals with a sound foundation for making encouraging predictions about their patients' long-term physical recovery after cancer. Cancer patients also will welcome the news that only a minority of five-year survivors experience long-term and late effects.

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  • Survivors' heightened symptoms have a substantial negative impact on their daily activities, functional status, and quality of life.

    “Survivors’ heightened symptoms have a substantial negative impact on their daily activities, functional status, and quality of life [4–6].”

    From Symptom experiences in post-treatment cancer survivors: associations with acceptance and commitment therapy constructs. (2021) · cites this paper as [6]

    The Cancer-Specific Physical Symptoms section reports that pain interfered with daily activities for 6% of colorectal cancer survivors, and the Introduction discusses continuing physical limitations and symptoms. But the paper does not establish a substantial negative impact of heightened symptoms across survivors’ functional status and quality of life; it reports generally low symptom levels and good global quality of life among long-term survivors. (LLM, conf=0.85)

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  • Cancer-related symptoms rarely occur alone and often form a symptom cluster with multiplicative effects.

    “Such symptoms rarely occur in isolation but form a symptom cluster that often has multiplicative effects [13].”

    From Acceptance and commitment therapy in adult cancer survivors: a systematic review and conceptual model (2021) · cites this paper as [13]

    The Introduction says physical symptoms tend not to occur in isolation and that patients often experience multiple symptoms concurrently. It also says their impact on well-being can be multiplicative rather than additive, but does not establish that multiplicative effects often occur. (LLM, conf=0.86)

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1 of the 40 references couldn’t be matched to a known paper.

Research works printed but not linked: 3

  1. Verdecchia A, Francisci S, Brenner H, et al. The EUROCARE-4 Working Group. Recent cancer sur- vival in Europe: a 2000e02 period analysis of EUROCARE-4 data. Lancet Oncol 2007;8:784e796.
  2. Miaskowski C, Dodd M, Lee K. Symptom clus- ters: the new frontier in symptom management re- search. J Natl Cancer Inst Monographs 2004;32: 17e21.
  3. Hosmer D, Lemeshow S. Applied logistic regres- sion. New York: Wiley, 1989.

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Authors
Zucca, A. C., Boyes, A. W., Linden, W., & Girgis, A.
Affiliations
  • Hunter Medical Research Institute (AU)
  • BC Cancer Agency (CA)
Corresponding author
Zucca, Alison C.
ORCID
Venue
Journal of Pain and Symptom Management
Publisher
Elsevier BV
Published
2012-04
Volume
43
Issue
4
Pages
720-731
ISSN
0885-3924 (ISSN-L)
DOI
10.1016/j.jpainsymman.2011.04.023
OpenAlex
W1993462748
Cited by
83
References
40
Citations by year
2026: 3 · 2025: 2 · 2024: 6 · 2023: 3 · 2022: 5 · 2021: 3 · 2020: 9 · 2019: 8 · 2018: 6 · 2017: 3 · 2016: 4 · 2015: 10 · 2014: 10 · 2013: 8 · 2012: 3
FWCI
4.91
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Pain and Symptom Management (publishedVersion)
  • PubMed (publishedVersion)
  • Figshare (submittedVersion)
  • NOVA (University of Newcastle Australia) (submittedVersion, cc-by-nc-nd)
Funders
  • Cancer Council NSW
  • the Hunter Medical Research Institute
  • Supportive Cancer Care, Canadian Institutes for Health Research (#AQC83559)
Topics
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Childhood Cancer Survivors' Quality of Life
  • Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
Keywords
long-term cancer survivors, quality of life, breast cancer survivors, prostate cancer survivors, colorectal cancer survivors, melanoma survivors, cancer type differences, late effects of cancer, fatigue, insomnia, pain, dyspnea, constipation, diarrhea, nausea and vomiting, cognitive function, EORTC QLQ-C30
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Australia, Fatigue, Female, Humans, Male, Middle Aged, Nausea, Neoplasms, Pain, Quality of Life, Risk Factors, Comorbidity, Prevalence, Survivors, Risk Assessment, Young Adult

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