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Predictors of persistence of post-chemotherapy symptoms among survivors of solid tumor cancers

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Abstract

Context

Late or residual symptoms diminish quality of life for many cancer survivors after completion of treatment.

Objectives

Examine risk factors associated with persisting symptom burden after chemotherapy and the lack of symptom improvement over time.

Methods

Survivors who completed curative-intent chemotherapy within two years for solid tumors were enrolled into a symptom management trial. There were 375 survivors with two or more comorbid conditions or one comorbid condition and elevated depressive symptoms (pre-defined risk factors in the trial design) who received interventions and 71 survivors without these risk factors who did not receive interventions. For all survivors, symptoms were assessed at intake, 4, and 13 weeks and categorized as mild, moderate, or severe based on the interference with daily life. The probabilities of moderate or severe symptoms and symptom improvement were analyzed using generalized mixed-effects models in relation to comorbidity, depressive symptoms, age, sex, race/ethnicity, employment, time since chemotherapy completion, and physical function. Multiple symptoms were treated as nested within the survivor.

Results

Moderate or severe symptoms at baseline and the lack of improvement over time were associated with younger age and lower physical function over and above a greater number of comorbidities and elevated severity of depressive symptoms.

Conclusion

Risk factors identified in this research (younger age, lower physical function, greater comorbidity, and higher depressive symptoms) can be used to allocate resources for post-treatment symptom management for cancer survivors in order to relieve symptoms that do not necessarily resolve with time.

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Funding

This study was supported by a supplement to an R01 grant from the National Institutes of Health, Post-chemotherapy Symptom Management: Testing Intervention Sequences in a SMART Design (R01 CA225615-01). MPIs: T. Badger/A. Sikorskii. Data were collected using the Behavioral Intervention and Measurement Shared Resource at the University of Arizona Cancer Center (P30 CA023074).

Author information

Authors and Affiliations

  1. Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, 909 Wilson Road, Road 321, East Lansing, MI, 48824, USA

    Alla Sikorskii

  2. College of Nursing, Department of Psychiatry and Mel and Enid Zuckerman College of Public Health, University of Arizona, 1305 N. Martin Avenue, Tucson, AZ, 85721, USA

    Terry Badger

  3. Department of Communication, University of Arizona, Tucson, USA

    Chris Segrin

  4. Miller School of Medicine, Division of Medical Oncology, Sylvester Comprehensive Cancer Center, University of Miami, Coral Gables, USA

    Tracy E. Crane

  5. University of Arizona, Tucson, USA

    Nathan Cunicelli

  6. Division of Hematology-Oncology, George Washington University, Washington, DC, USA

    Pavani Chalasani

  7. College of Medicine, University of Arizona, Phoenix, AZ, USA

    Waqas Arslan

  8. College of Nursing, Michigan State University, East Lansing, USA

    Charles Given

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  1. Alla Sikorskii
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Contributions

Conceptualization: AS, TB, CS, TC, and CG. Data curation: AS, TB, CS, TC, PC, and WA. Formal Analysis: AS and NC. Methodology: AS, TB, CS, TC, and CG. Supervision: TB, CS, and AS. Writing of the original draft: AS, TB, and CS. Writing, reviewing, & editing of the manuscript: all authors. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Alla Sikorskii.

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Competing interests

The authors have no relevant financial or non-financial interests to disclose.

Data availability

We will share the data upon request made to first author (Alla Sikorskii) based on the principles that NIH has articulated regarding sharing of study results and resources. Data from this study will be available to other researchers and key stakeholders under the following conditions: 1) appropriate human subjects protection is in place; 2) data have been de-identified; and 3) study investigators have publicly presented and published key findings.

Code availability

SAS code used to produce the results is available upon request made to the first author (Alla Sikorskii).

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Review Board of the University of Arizona, protocol number Protocol 1711069340.

Consent to participate

Informed consent was obtained from all participants of the study.

Consent for publication

The manuscript does not contain any individual personal data. All data are presented on aggregate so that no individual can be identified.

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Sikorskii, A., Badger, T., Segrin, C. et al. Predictors of persistence of post-chemotherapy symptoms among survivors of solid tumor cancers. Qual Life Res 33, 1143–1155 (2024). https://doi.org/10.1007/s11136-023-03595-8

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