Symptom burden in cancer survivors 1 year after diagnosis§

A Report From the American Cancer Society's Studies of Cancer Survivors


  • Presented as a poster at the Annual Meeting of the American Society of Clinical Oncology, Chicago, Illinois, June 4-8, 2010.

  • The authors acknowledge Jeanie F. Woodruff, ELS, of the Department of Symptom Research at The University of Texas MD Anderson Cancer for editorial assistance and Dr. Xianglin Du of The University of Texas School of Public Health for review and comment on the article.

  • §

    The American Cancer Society acknowledges the cooperation and efforts of the cancer registries and public health departments from the states of Alabama, Connecticut, Iowa, Idaho, Minnesota, New Jersey, Ohio, Pennsylvania, Rhode Island, South Carolina, and Wyoming. We also thank the staff of the hundreds of hospitals, including Stamford Hospital, who reported cases to the participating cancer registries. Last, we are grateful to the thousands of cancer survivors, their physicians, and their loved ones who contributed to the collection of these data.

  • Qiuling Shi had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.



Few studies have examined risk for severe symptoms during early cancer survivorship. By using baseline data from the American Cancer Society's Study of Cancer Survivors-I, the authors examined cancer survivors with high symptom burden, identified risk factors associated with high symptom burden, and evaluated the impact of high symptom burden on health-related quality of life (HRQoL) 1 year postdiagnosis.


Participants were enrolled from 11 state cancer registries approximately 1 year after diagnosis and were surveyed by telephone or mail. The outcomes measures used were the Modified Rotterdam Symptom Checklist and the Profile of Mood States-37 (to assess symptom burden) and the Satisfaction with Life Domains Scale-Cancer (to assess HRQoL).


Of 4903 survivors, 4512 (92%) reported symptoms related to their cancer and/or its treatment. Two-step clustering yielded 2 subgroups, 1 with low symptom burden (n = 3113) and 1 with high symptom burden (n = 1399). Variables that were associated with high symptom burden included lung cancer (odds ratio [OR], 2.27), metastatic cancer (OR, 2.05), the number of comorbid conditions (OR, 1.76), remaining on active chemotherapy (OR, 1.93), younger age (OR, 2.31), lacking insurance/being underinsured (OR, 1.57), having lower income (OR, 1.61), being unemployed (OR, 1.27), and being less educated (OR, 1.29). Depression, fatigue, and pain had the greatest impact on HRQoL in survivors with high symptom burden, who also had lower HRQoL (P < .0001).


More than 1 in 4 cancer survivors had high symptom burden 1 year postdiagnosis, even after treatment termination. These results indicate a need for continued symptom monitoring and management in early post-treatment survivorship, especially for the underserved. Cancer 2011;. © 2011 American Cancer Society.