Multiple Co-occurring Symptoms in Patients with Gastrointestinal Cancers

Abstract

Background: Patients with gastrointestinal (GI) cancers experience 10 to 15 co-occurring symptoms during chemotherapy that decrease their functional status, quality of life (QOL), and overall survival. The purposes of this dissertation were to describe symptom experiences and self-management strategies for multiple co-occurring symptoms in patients with gastric cancer; identify the subgroups of patients with GI cancers based on their distinct symptom experience profiles; and determine differences among these subgroups in demographic and clinical characteristics, as well as co-occurring symptoms and QOL outcomes. Methods: An integrative review, a qualitative study, and three quantitative studies (i.e., one was cross-sectional, two were longitudinal) were used in this dissertation. Twenty-five studies were included and systematically evaluated in the review. Ten participants were interviewed for their symptom experiences and self-management strategies. Patients (n=405) completed questionnaires (e.g., the Memorial Symptom Assessment Scale, the Lee fatigue Scale, the General Sleep Disturbance Scale) six times over two cycles of chemotherapy. Content analysis was used to analyze the qualitative data. Latent class/profile analysis was used to identify the subgroups of patients with distinct symptom profiles. Differences in demographic and clinical characteristics as well as co-occurring symptoms and QOL outcomes among the subgroups were evaluated using parametric and non-parametric analyses. Results: The most common symptoms were categorized into physical and affective/cognitive domains. Patients reported a large amount of inter-individual variability and dynamic nature in their experiences of multiple co-occurring symptoms. Four symptom self-management strategies were identified: medications for symptoms, information-seeking from the clinician team, lifestyle modifications, and psychosocial and spiritual support. The risk factors for a higher symptom burden included younger age, not being married/partnered, being unemployed, having childcare responsibilities, lack of regular exercise, having a lower functional status, having a higher comorbidity burden, and self-reported diagnosis of depression. Patients with a more severe symptom profile reported higher levels of morning and evening fatigue, sleep disturbance, anxiety, depressive symptoms, and pain, as well as lower levels of attentional function and QOL scores at enrollment. Conclusions and Implications: This dissertation is the first to identify the subgroups of patients with GI cancers with distinct symptom experience profiles and examine a number of risk factors associated with more severe symptom profiles, as well as describe symptom experiences and self-management strategies for multiple co-occurring symptoms in patients with gastric cancer. Additional research is warranted to explore underlying mechanisms that contribute to the development of multiple co-occurring symptoms during chemotherapy. Clinicians need to assess for common risk factors and associated co-occurring symptoms, as well as initiate personalized symptom management interventions and referrals.