Symptom distress prevalent among cancer survivors

Symptom distress is prevalent among cancer survivors, according to data from the city’s first community-based multidisciplinary cancer survivorship clinic set up by the University of Hong Kong (HKU) Jockey Club Institute of Cancer Care (JCICC).

Among 512 cancer survivors who have attended the cancer survivorship clinic since 2020 (50–69 years of age, 65 percent; female, 81 percent; secondary education or above, 83 percent; unemployed, 50 percent), 29 percent (n=149) had clinical symptom distress, as measured by an Edmonton Symptom Assessment System (ESAS) score of ≥7 on a scale of 0–10. Subclinical symptom distress (ESAS score 4–6) was reported by 48 percent (n=246) of clinic attendees.

“Among attendees with clinical symptom distress, the most common symptom was sleep disturbance [52 percent], followed by neuropathy [38 percent], anxiety [36 percent], and depression [26 percent],” said Dr Wendy Lam, Director of HKU JCICC.

Among those with severe anxiety or depressive symptoms, 90 percent had grave concerns about cancer recurrence.

In the cohort, the most common cancer type was breast cancer (62 percent), followed by colorectal cancer (15 percent). A majority (94 percent) of clinic attendees have been treated with surgery, while 51 percent and 45 percent are currently receiving radiotherapy and chemotherapy, respectively.

Anthropometric, physical fitness and dietary assessments revealed at least one suboptimal health indicator among 13 indicators measured. Two-thirds (67 percent) of the clinic attendees had ≥4 suboptimal health indicators, while 17 percent had ≥7 suboptimal indicators.

For instance, 20 percent of the clinic attendees were overweight, while 33 percent were obese. Waist circumference measurement revealed central obesity in 59 percent of the clinic attendees.

Leg strength (as measured by 30-second sit-to-stand test) and grip strength were below standard in 30 percent and 85 percent of the clinic attendees, respectively, while cardiovascular function (as measured by 6-minute walk test) was below standard in 73 percent of the clinic attendees.

In terms of dietary pattern, 49 percent of clinic attendees overconsumed red meat (ie, >3 portions per week). Consumption of whole grains, fruits and vegetables, and skin carotenoid was low in 47 percent, 35 percent and 7 percent of the clinic attendees, respectively.

“Patients on active cancer treatment receive routine symptom assessment and management, but symptom monitoring often becomes infrequent [for example, every 3–6 months or annually] beyond the treatment phase,” said Lam.

At the HKU JCICC cancer survivorship clinic, patients with clinical symptom distress are managed and regularly followed up for 5 years by nurses who serve as case managers.

“Our multidisciplinary care includes psychosocial consultation, personalized fitness assessment and consultation, and personalized nutritional assessment and dietary consultation,” Lam continued. “More than 80 percent of clinic attendees said the advice they received from our fitness trainers, dietitians and nurses adequately addressed their concerns, and 94 percent would recommend the clinic to other patients.”