Many patients with cancer have a cluster of common symptoms, which should be acknowledged and addressed, as they can help improve quality of life, say researchers reporting a new study.
A team from the Regenstrief Institute in Indianapolis, the Mayo Clinic, and Yale University looked at a range of symptoms clubbed together under the acronym SPPADE — sleep disturbance, pain, physical function impairment, anxiety, depression, and low energy/fatigue.
The study involved 31,866 patients who were asked to complete questionnaires about these SPPADE symptoms before, during, or soon after an outpatient medical oncology encounter.
The study found that over half of patients experienced three or more SPAADE symptoms.
“The high prevalence and co-occurrence rates of the six SPPADE symptoms may warrant multi-symptom rather than single-symptom screening in patients with cancer as well as management strategies that acknowledge more than one symptom may require attention,” the team concludes.
“[SPPADE] symptoms are often clustered. So, having only one of these symptoms is an exception,” lead author Kurt Kroenke, MD, research scientist at Regenstrief and Indiana University School of Medicine, told Medscape Medical News. “If a person has one of these symptoms, they have an average of two to three of the others, and so the fact is if we can find treatments that work across symptoms that would be beneficial.”
The study was published in February in the Journal of Pain and Symptom Management.
Kroenke noted that these common symptoms are often overlooked.
“It’s understandable that during a busy appointment, discussions of symptoms tend to focus on those that the physician considers more directly attributable to their disease and its treatment — such as nausea, vomiting, mouth sores, neuropathy — rather than SPPADE symptoms,” he said in a press release.
“But it’s important for cancer patients to know sleep disturbance, pain, physical function impairment, anxiety, depression, and low energy/fatigue, while perhaps related to other factors in addition to their cancer, are not uncommon and that we have simple ways of measuring, and effective ways of managing, these often-debilitating symptoms.”
Researchers also examined SPPADE symptoms by type of cancer and eight sociodemographic variables (age, sex, race, ethnicity, education, marital status, employment status, and payor) from electronic health records.
The study found that the proportion of patients with “clinically relevant” symptoms ranged from 17.5% for depression to 33.4% for fatigue.
For each symptom, co-occurrence of other symptoms was common. Fatigue had the highest co-occurrence rates, with each of the other symptoms present in 66%-74% of fatigued patients. Apart from fatigue, co-occurrence rates exceeded two thirds for physical function impairment in patients with pain, and for depression-anxiety co-occurrence.
Compared with breast cancer (which was used as a reference because it had the lowest mean SPPADE score), the effect size for SPPADE symptom burden was largest for lung cancer (0.41), followed by noncolorectal GI (0.39), prostate (0.30), other (0.24), and gynecologic (0.20) cancer.
“There were some modest differences among types of cancers, but most of the cancers had a pretty consistent level of symptoms,” Kroenke said. “And so the take-home message is [that] regardless of cancer type or regardless of age or sex, these SPPADE symptoms are as important…it’s not particularly important to just one group of cancer type of patient, but to all.”
Symptom burden was also generally similar across most sociodemographics. However, researchers noted that the majority of study participants were non-Hispanic White, warranting “further exploration of race and ethnicity effects on symptom burden in more diverse samples.”
Symptom burden was also higher in those whose employment status was disabled (effect size of 0.61), who were African American (0.22), and who had Medicaid (0.32) or insurance other than commercial, Medicare, or self-pay (0.24). Finally, the symptom burden was smaller in those with a college degree (-0.22) or a more advanced postgraduate degree (-0.24).
The authors noted that the lack of a diverse population was a significant limitation of the study. Out of the 31,886 patients, over 30,000 identified as Non-Hispanic White. In addition, most study participants were college educated and were either employed or retired. Over half of the participants (57.7%) were women.
Kroenke also said that the study didn’t include symptoms at different stages of cancer, newly diagnosed, end of life, etc. He noted that it will be included in future studies.
The study was funded by the National Cancer Institute. The authors report no relevant financial relationships.
J Pain Symptom Manage. Published online February 2, 2023. Abstract
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