Associations of Symptom Clusters and Health Outcomes in Adult Survivors of Childhood Cancer: A Report From the St Jude Lifetime Cohort Study

Abstract

Purpose: To identify symptom clusters among adult survivors of childhood cancers and test associations with health-related quality of life (HRQOL) and physical and neurocognitive performance.

Methods: This cross-sectional study included 3,085 survivors (mean age at evaluation 31.9 ± 8.3 years; mean years from diagnosis 28.1 ± 9.1) participating in the St Jude Lifetime Cohort Study. Survivors self-reported the presence of 37 symptoms capturing 10 domains (cardiac, pulmonary, sensory, motor/movement, nausea, pain, fatigue, memory, anxiety, and depression). The Short Form-36's Physical/Mental Component Summaries assessed HRQOL; the Physical Performance Test evaluated physical performance; and neurocognitive batteries tested attention, processing/psychomotor speed, memory, and executive function. Latent class analysis identified subgroups of survivors experiencing different patterns of symptom burden (ie, symptom clusters). Multivariable regression models identified risk of cluster membership and tested associations with health outcomes.

Results: Four symptom clusters were identified including cluster 1 (prevalence 52.4%; low physical, somatization, and psychologic domains), cluster 2 (16.1%; low physical, moderate somatic, and high psychologic domains), cluster 3 (17.6%; high physical, moderate somatic, and low psychologic domains), and cluster 4 (13.9%; high in all three domains). Compared with cluster 1, survivors in cluster 4 were more likely to have less than high school education (odds ratio [OR], 7.71; 95% CI, 4.46 to 13.31), no insurance (OR, 1.49; 95% CI, 1.04 to 2.13), and exposure to corticosteroids (OR, 1.76; 95% CI, 1.02 to 3.03); survivors in cluster 3 were more likely to have received platinum agents (OR, 2.22; 95% CI, 1.34 to 3.68) and brain radiation ≥ 30 Gy (OR, 3.99; 95% CI, 2.33 to 6.86). Survivors in cluster 4 reported the poorest Physical Component Summary/Mental Component Summary scores (31.0/26.7) and physical and neurocognitive performance versus survivors in the other clusters (P < .001).

Conclusion: Nearly 50% of survivors had moderate to high multisymptom burden, which was associated with sociodemographic, treatment factors, HRQOL, and functional outcomes.

FIG 1.

The cluster pattern of 10 symptom domains.^{a,b a}Symptom cluster 1 = low physical, somatic, and psychologic symptoms; symptom cluster 2 = low physical, moderate somatic, and high psychologic symptoms; symptom cluster 3 = high physical, moderate somatic, and low psychologic symptoms; symptom cluster 4 = high physical, somatic, and psychologic symptoms. ^bCluster size (%) in cluster 1: n = 1,617 (52.4%); cluster 2: n = 497 (16.1%); cluster 3: n = 544 (17.6%); cluster 4: n = 427 (13.9%).

FIG 2.

Prevalence of symptoms clusters^a by four major cancer diagnosis groups. ^aSymptom cluster 1 = low physical, somatic, and psychologic symptoms; symptom cluster 2 = low physical, moderate somatic, and high psychologic symptoms; symptom cluster 3 = high physical, moderate somatic, and low psychologic symptoms; symptom cluster 4 = high physical, somatic, and psychologic symptoms.

FIG A1.

The process of recruiting study participants (adult survivors of childhood cancer).