November 2017 VOL 8, NO 11
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Patient-Reported Symptoms Reduce Health-Related Quality of Life Among Patients Undergoing Treatment for Metastatic Cancer
Dana Drzayich Antol, MS1; Adrianne W. Casebeer, PhD, MPP, MS1; Sari Hopson, PhD, MSPH1; Raya Khoury, MPH2; Aparna Parikh, MD2; Alisha Stein, RN-BC, MSN, OCN2; Todd Michael, PharmD, RPh2; Stephen Stemkowski, PhD, MHA1; Mikele Bunce, PhD, MPH2
1Comprehensive Health Insights, Humana, Louisville, KY; 2Genentech, San Francisco, CA
Background: Symptoms that patients with cancer experience, either due to their illness or as a result of cancer treatment, are known to diminish their health-related quality of life.
Objectives: This study investigated the magnitude of the decrease in health-related quality of life attributable to patient-reported symptoms.
Methods: In 2015, we surveyed 7432 Humana patients undergoing treatment for metastatic breast, lung, or colorectal cancer with at least 1 comorbid condition. Health-related quality of life was measured on this survey using the Centers for Disease Control and Prevention’s Healthy Days Core Module. Patients were asked to indicate separately how many days in the past 30 days their physical and mental health was not good. The number of physically and mentally Unhealthy Days were summed, with a maximum of 30, to indicate the total number of Unhealthy Days. Total number of Unhealthy Days was dichotomized to indicate frequent Unhealthy Days (≥14) in the past 30 days. The degree to which patients experienced cancer-related symptoms (pain, fatigue, diarrhea/constipation, nausea/vomiting, or shortness of breath) in the past 30 days was captured using a 5-point Likert scale ranging from never to always. For analysis, patient-reported symptoms rated as sometimes/often/always were considered present, and those rated as never/rarely were considered absent. Continuous variables were compared using t tests and are presented as mean (SD); categorical variables were compared using chi-square tests and reported as n (%).
Results: Of the 1780 (24%) eligible survey respondents, 67.3% were female; 88.0% had Medicare coverage; and the mean age was 69.1 (9.2) years. Fatigue was the symptom most frequently reported (64.9%), followed by pain (47.3%), shortness of breath (38.1%), diarrhea/constipation (37.4%), and nausea/vomiting (18.1%). Among patients with frequent Unhealthy Days, a statistically greater proportion of each symptom was reported (at P <.001 level). Pain was reported by 70.4% of patients with frequent Unhealthy Days; 86.3% reported fatigue; 64.0% reported shortness of breath; 50.9% reported diarrhea/constipation, and 27.0% reported nausea/vomiting (P <.001). The mean difference in the number of Unhealthy Days was evaluated for each symptom. Patients reporting pain or fatigue had the greatest average increase in total Unhealthy Days in relation to those without pain (20.9 [10.4] vs 8.8 [10.1]; P <.0001) or fatigue (18.8 [11.1] vs 6.6 [8.9]; P <.001). Patients experiencing shortness of breath had 9.3 more Unhealthy Days than those without shortness of breath (20.3 [10.9] vs 11.0 [11.0]; P <.001). Patients with nausea/vomiting had 8.2 more Unhealthy Days than patients without nausea/vomiting (21.2 [10.7] vs 12.0 [11.6]; P <.001). Patients experiencing diarrhea/constipation had 7.2 more Unhealthy Days than those without diarrhea/constipation (19.0 [11.4] vs 11.8 [11.3]; P <.001).
Conclusions: Patient-reported cancer-related symptoms, especially pain and fatigue, accounted for a substantial increase in Unhealthy Days among patients with cancer actively undergoing treatment. Interventions aimed at ameliorating these symptoms may improve health-related quality of life for patients undergoing treatment for cancer.
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