Symptom Clusters in Adult Survivors of Childhood Cancer

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In a report from the St. Jude Lifetime Cohort Study population reported in the Journal of Clinical Oncology, Shin et al identified symptom clusters among adult survivors of childhood cancer and potential associations with health-related quality of life and physical and neurocognitive performance.

Study Details

The study included 3,085 survivors with a mean age at study evaluation of 31.9 years and mean time from diagnosis of 28.1 years. Survivors self-reported the presence of 37 symptoms within 10 domains. The 10 domains captured three symptom groups:

  • Physical (sensation, motor/movement, cardiac, and pulmonary domains)
  • Somatic (pain, fatigue, and nausea domains)
  • Psychologic (memory, anxiety, and depression domains).

The Short Form-36 Physical/Mental Component Summaries assessed health-related quality of life; the Physical Performance Test evaluated physical performance; and neurocognitive batteries assessed attention, processing/psychomotor speed, memory, and executive function.

Key Findings

A total of four symptom clusters were identified:

  • Cluster 1 consisted of low physical, somatic, and psychologic domain symptom burdens, representing 52.4% of the population
  • Cluster 2 consisted of low physical, moderate somatic, and high psychologic domain symptom burdens, representing 16.1% of the population
  • Cluster 3 consisted of high physical, moderate somatic, and low psychologic domain symptom burdens, representing 17.6% of the population
  • Cluster 4 consisted of high symptom burdens in all three domains, representing 13.9% of the population.

Compared with survivors in cluster 1, those in cluster 4 were more likely to have less than high school education (odds ratio [OR] = 7.71, 95% confidence interval [CI] = 4.46–13.31), no health insurance (OR = 1.49, 95% CI = 1.04–2.13), and exposure to corticosteroids (OR = 1.76, 95% CI = 1.02–3.03).

Compared with survivors in cluster 1, those in cluster 3 were more likely to have received platinum agents (OR = 2.22, 95% CI = 1.34–3.68) and brain radiation ≥ 30 Gy (OR = 3.99, 95% CI = 2.33–6.86).

Survivors in cluster 1 had the highest and survivors in cluster 4 the lowest Physical Component Summary scores (overall P < .001), Mental Component Summary scores (overall P < .001), Physical Performance Test scores (overall P < .001), and neurocognitive performance scores (overall P < .001).

The investigators concluded, “Nearly 50% of survivors had moderate to high multisymptom burden, which was associated with sociodemographic, treatment factors, [health-related quality of life], and functional outcomes.”

I-Chan Huang, PhD, of the Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: The study was supported by the National Cancer Institute. For full disclosures of the study authors, visit

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.