Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 2115 Wisconsin Ave NW, Suite 300, Washington, DC, 20007, USA.
Department of Population Health Sciences, Center for Health Measurement, Duke University School of Medicine, Durham, NC, 27701, USA.
J Cancer Surviv. 2022 Dec;16(6):1449-1460. doi: 10.1007/s11764-021-01123-6. Epub 2021 Nov 17.
PURPOSE: Our purpose was to describe the prevalence and predictors of symptom and function clusters in a diverse cohort of colorectal cancer survivors. METHODS: We used data from a cohort of 909 adult colorectal cancer survivors. Participants were surveyed at a median of 9 months after diagnosis to ascertain the co-occurrence of eight distinct symptom and functional domains. We used factor analysis to identify co-occurring domains and latent profile analysis (LPA) to identify subgroups of survivors with different symptom and function clusters. Multinomial logistic regression models were used to identify risk/protective factors. RESULTS: Factor analysis demonstrated a single underlying factor structure that included all eight health domains with depression and anxiety highly correlated (r = 0.87). The LPA identified three symptom and function clusters, with 30% of survivors in the low health-related quality of life (HRQOL) profile having the highest symptom burden and lowest functioning. In multivariable models, survivors more likely to be in the low HRQOL profile included being non-White, female, those with a history of cardiac or mental health conditions, and chemotherapy recipients. Survivors less likely to be in the low HRQOL profile included those with older age, greater financial well-being, and more spirituality. CONCLUSION: Nearly one-third of colorectal cancer survivors experienced a cluster of physical and psychosocial symptoms that co-occur with clinically relevant deficits in function. IMPLICATIONS FOR CANCER SURVIVORS: Improving the identification of risk factors for having the highest symptom and lowest function profile can inform the development of clinical interventions to mitigate their adverse impact on cancer survivors' HRQOL.
目的:本研究旨在描述不同结直肠癌幸存者队列中症状和功能群的发生率及其预测因素。
方法:我们使用了一个由 909 例成年结直肠癌幸存者组成的队列的数据。参与者在诊断后中位数 9 个月时接受调查,以确定 8 个不同的症状和功能域的同时发生情况。我们使用因子分析确定共同发生的域,使用潜在剖面分析(LPA)确定具有不同症状和功能群的幸存者亚组。使用多项逻辑回归模型确定风险/保护因素。
结果:因子分析显示出单一的潜在因素结构,包括所有 8 个健康领域,其中抑郁和焦虑高度相关(r=0.87)。LPA 确定了三个症状和功能群,30%的低健康相关生活质量(HRQOL)幸存者的症状负担最高,功能最低。在多变量模型中,更有可能处于低 HRQOL 特征的幸存者包括非白人、女性、有心脏或心理健康病史以及接受化疗的幸存者。不太可能处于低 HRQOL 特征的幸存者包括年龄较大、经济状况较好和精神信仰较强的幸存者。
结论:近三分之一的结直肠癌幸存者经历了一组身体和心理社会症状,这些症状与功能方面的临床相关缺陷同时发生。
对癌症幸存者的意义:改善对具有最高症状和最低功能特征的风险因素的识别,可以为制定临床干预措施提供信息,以减轻其对癌症幸存者 HRQOL 的不利影响。
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