Investigators have revealed the findings from an examination of the prevalence, severity, and co-occurrence of sleep disturbance, pain, physical function impairment, anxiety, depression, and low energy/fatigue (SPPADE) symptoms, as well as their association with different cancer types and patient characteristics, according to a new study published by Kroenke et al in the Journal of Pain and Symptom Management.
Background
SPPADE symptoms are often common, co-occurring, and undertreated in patients with cancer. The investigators noted that managing these symptoms may improve patients’ quality of life.
“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, and neuropathy—rather than SPPADE symptoms,” explained lead study author Kurt Kroenke, MD, MACP, Professor of Medicine at the Indiana University School of Medicine, Chancellor’s Professor at the Indiana University–Purdue University Indianapolis, and a research scientist at the William M. Tierney Center for Health Services Research at the Regenstrief Institute.
“But it’s important for patients [with cancer] to know [that SPPADE symptoms]—while perhaps related to other factors in addition to their cancer—are not uncommon, and that we have simple ways of measuring [as well as] effective ways of managing these often-debilitating symptoms,” he added.
Study Methods and Results
In the new study, the investigators interviewed 31,886 patients with cancer and assessed their SPPADE symptoms prior to, during, or soon after an outpatient medical oncology appointment. They discovered that SPPADE symptoms were pervasive across patients with all cancer types and sociodemographics.
The investigators further noted several of their new findings:
- Cancer type may have been associated with modest differences in the patients’ symptom burden—with higher symptom burden potentially linked to lung cancer, gastrointestinal cancer (other than colorectal cancer), and gynecologic cancer.
- Symptom burden was generally similar across most sociodemographics.
- Older patients did not report higher symptom rates, and these symptoms did not appear to differ by sex.
- There was a modest association of symptom burden with disabled employment status, Medicaid as a payor, and lower educational attainment.
- The proportion of patients with symptoms ranged from 17.5% for depression to 33.4% for fatigue.
- Co-occurring symptoms were significantly more common than a single symptom; the proportion of patients with three or more symptoms ranged from 45.2% for fatigue to 68.6% for depression.
Conclusions
“Because SPPADE symptoms are highly prevalent and their effects relate more to morbidity and quality of life than mortality, it is important to minimize overdiagnoses while at the same time optimizing treatments in patients most needing or desiring [them]. Thus, prioritizing symptoms that warrant treatments should integrate several factors, including symptom characteristics—severity, time course, treatability, and rapidity of response—as well as patient preferences,” concluded Dr. Kroenke and his colleagues.
Disclosure: The research in this study was supported by the National Cancer Institute of the National Institutes of Health. For full disclosures of the study authors, visit jpsmjournal.com.
