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Cancers
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Symptom Burden in Cancer: Assessment and Management
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Symptom Burden in Cancer: Assessment and Management

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Survivorship and Quality of Life".

Deadline for manuscript submissions: closed (20 April 2025) | Viewed by 4141

Special Issue Editors

Prof. Dr. Sam M. Salek

E-Mail Website
Guest Editor
School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK
Interests: development, evaluation and application of patient-reported outcome (PRO); pharmacoeconomics; cancer syndrome; survivorship; quality of life
Dr. Esther Natalie Oliva

E-Mail Website
Guest Editor
U.O.C. Ematologia, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, 89124 Reggio di Calabria, Italy
Interests: Myelodysplastic syndromes; acute myeloid leukemia; immune thrombocytopenia; anemia; patient-reported outcomes; quality of life
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Tatyana Ionova

E-Mail Website
Guest Editor
Quality of Life Unit, Saint Petersburg State University Hospital, 190103 Saint Petersburg, Russia
Interests: quality of life; patient-reported outcomes; cancer symptoms; healthcare; symptom assessment; survivorship

Special Issue Information

Dear Colleagues,

Cancer and its treatment are accompanied by multiple symptoms that may significantly distress patients and impair their quality of life. These symptoms may delay successful treatment or lead to premature treatment termination. Cancer survivors are at risk of multiple severe and persistent symptoms. The control of disease-related and treatment-related symptoms is an integral component of cancer care. It is well established that optimal symptom management is based on adequate symptom assessment. The implementation of patient-reported outcomes to assess symptom burden is of great significance, and symptom burden surveillance should be performed and managed during cancer treatment. Strategies for assessing symptom burden and its management in patients with various types of cancer is a subject of ongoing investigation. In addition, the burden of symptoms in cancer on family members and family resilience are further focuses of research. Recently, patient empowerment in cancer care in building up patient–provider partnerships through shared decision making has also been highlighted.

This Special Issue covers areas such as strategies for the assessment of symptom burden and symptom management in cancer, optimizing cancer care for improved management of symptoms, the impact of symptom burden on patients with various types of cancers and their families, and patient-centered empowerment strategies for better managing cancer symptoms.

Prof. Dr. Sam M. Salek
Dr. Esther Natalie Oliva
Prof. Dr. Tatyana Ionova
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • symptom burden
  • patient-reported outcomes
  • symptom assessment
  • symptom management
  • quality of life

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Published Papers (4 papers)

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Research

16 pages, 794 KiB  
Article
Unmet Needs and Their Impact on Quality of Life and Symptoms in Myelodysplastic Neoplasm Patients and Caregivers
by Elena Crisà, Daniela Cilloni, Marta Riva, Enrico Balleari, Daniela Barraco, Beatrice Manghisi, Lorenza Borin, Michela Calmasini, Anna Calvisi, Isabella Capodanno, Matteo Giovanni Della Porta, Elisa Diral, Bruno Fattizzo, Susanna Fenu, Stefania Paolini, Carlo Finelli, Claudio Fozza, Chiara Frairia, Valentina Giai, Mauro Turrini, Maria Antonia Isoni, Federico Itri, Luca Maurillo, Alfredo Molteni, Giuseppe Alberto Palumbo, Anna Maria Pelizzari, Federica Pilo, Antonella Poloni, Costanza Bosi, Grazia Sanpaolo, Rosaria Sancetta, Cristina Amato, Valeria Santini, Maria Teresa Voso, Sam Salek, Tatyana Ionova, Annamaria Nosari and Esther Natalie Olivaadd Show full author list remove Hide full author list
Cancers 2025, 17(9), 1587; https://doi.org/10.3390/cancers17091587 - 7 May 2025
Viewed by 247
Abstract
Background/Objectives: The aim of this study was to assess the unmet needs of myelodysplastic neoplasm (MDS) patients and their caregivers, focusing on how these needs impact quality of life (QoL) and daily functioning. MDS predominantly affects older adults. It is often complicated by [...] Read more.
Background/Objectives: The aim of this study was to assess the unmet needs of myelodysplastic neoplasm (MDS) patients and their caregivers, focusing on how these needs impact quality of life (QoL) and daily functioning. MDS predominantly affects older adults. It is often complicated by severe red blood cell transfusion-dependent anemia and may require frequent hospital visits, conferring a substantial burden on patients and caregivers. Methods: A national survey was conducted between June 2022 and May 2023 in 46 hematology centers across Italy, involving 259 patients and 105 caregivers. The survey included validated QoL tools (QOL-E and HM-PRO) to measure the impact of disease and treatments on health-related QoL and symptoms. Results: Of the 259 patients surveyed, 42% were transfusion-dependent, with 45% reporting distress related to hospital travel, which was significantly associated with lower QoL scores (QOL-E physical score 50.0 vs. 62.5, p < 0.001). Transfusion dependency led to worse outcomes across physical, emotional, and social domains (HM-PRO Part A score 59.8 vs. 23.7, p < 0.001). Anxiety affected 66% of patients, while 56% reported feeling emotionally distressed. Forty-eight percent of patients required a caregiver, and among caregivers, 29% reported significant disruption to their work, including changing their job or reduced hours. Patients requiring frequent hospital visits showed notably worse QoL scores (HM-PRO emotional score 56.8 vs. 31.8, p < 0.001). Conclusions: This study identified substantial unmet needs for MDS patients, particularly in addressing the heavy burden of transfusions and hospital visits. Both patients and caregivers experienced significant impact on daily life and on QoL, highlighting the urgent need for treatments that reduce hospital dependency, improve patient outcomes, and alleviate the caregiver burden. Full article
(This article belongs to the Special Issue Symptom Burden in Cancer: Assessment and Management)
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14 pages, 551 KiB  
Article
Feasibility and Acceptability of Integrating Acupuncture for Management of Multiple Symptoms in Medically Underserved Breast Cancer Survivors
by Hongjin Li, Ardith Z. Doorenbos, Zhengjia Chen, Hannah Choi, Weiwei Ma, Oana Danciu, Crystal L. Patil, Shuang Gao, Natalie Lif and Judith M. Schlaeger
Cancers 2025, 17(2), 304; https://doi.org/10.3390/cancers17020304 - 18 Jan 2025
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Abstract
Background/Objectives: Breast cancer survivors undergoing long-term endocrine therapy often experience multiple symptoms, including pain, fatigue, sleep disturbance, hot flashes, anxiety, and depression. This study explored the feasibility and acceptability of integrating acupuncture for symptom management in medically underserved breast cancer survivors. Methods: This [...] Read more.
Background/Objectives: Breast cancer survivors undergoing long-term endocrine therapy often experience multiple symptoms, including pain, fatigue, sleep disturbance, hot flashes, anxiety, and depression. This study explored the feasibility and acceptability of integrating acupuncture for symptom management in medically underserved breast cancer survivors. Methods: This randomized controlled trial was conducted at two clinics serving medically underserved populations. Breast cancer survivors (N = 62) were randomized to receive acupuncture (n = 31) or usual care (n = 31). The acupuncture group underwent 10 sessions over 5 weeks. Symptoms were assessed at baseline and Weeks 6 and 12. Results: The majority of participants (55%) were Black, mean age was 55.2 ± 9.3 years, and 62.9% had a household income below $55,000. Retention (90.3%), engagement (93.1%), and acceptability (92.8%) rates were high, demonstrating that integrating acupuncture into care for medically underserved breast cancer survivors is both feasible and acceptable. At Week 6, the acupuncture group showed significant reduction compared to the usual care group in pain, fatigue, sleep disturbance, depression, anxiety, and the symptom cluster score. All improvements persisted to Week 12 except for those in anxiety. Conclusions: Integrating acupuncture for symptom management in medically underserved breast cancer survivors is both feasible and acceptable. This approach offers potential benefits for reducing multiple symptoms and addressing health disparities. Full article
(This article belongs to the Special Issue Symptom Burden in Cancer: Assessment and Management)
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13 pages, 1197 KiB  
Article
Severity of Symptoms as an Independent Predictor of Poor Outcomes in Patients with Advanced Cancer Presenting to the Emergency Department: Secondary Analysis of a Prospective Randomized Study
by Aiham Qdaisat, Elizabeth Stroh, Cielito Reyes-Gibby, Monica K. Wattana, Jayne Viets-Upchurch, Ziyi Li, Valda D. Page, Huda Fatima, Patrick Chaftari and Ahmed Elsayem
Cancers 2024, 16(23), 3988; https://doi.org/10.3390/cancers16233988 - 28 Nov 2024
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Abstract
Background/Objectives: Patients with advanced cancer often present to the emergency department (ED) with pain and distressing symptoms that are not systematically evaluated. The current study investigated the association of symptom severity with the diagnosis of delirium and short-term survival. Methods: In [...] Read more.
Background/Objectives: Patients with advanced cancer often present to the emergency department (ED) with pain and distressing symptoms that are not systematically evaluated. The current study investigated the association of symptom severity with the diagnosis of delirium and short-term survival. Methods: In this secondary analysis of a prospective randomized study of delirium among advanced cancer patients in the ED, in which symptoms were assessed by the MD Anderson Symptom Inventory (MDASI), we analyzed the distribution of MDASI item scores by 90-day mortality (Kolmogorov–Smirnov), the association of MDASI item scores with short-term mortality (logistic regression models), and the symptoms in those with or without delirium (Mann–Whitney U test or chi-square test). Results: Of the 243 patients included, 222 (91.4%) had complete MDASI scores. The MDASI median symptom scores for pain, fatigue, and interference with work were the highest. A significant difference in MDASI item score distribution with 90-day mortality was observed for fatigue (p = 0.018), shortness of breath (p < 0.001), difficulty remembering (p = 0.038), lack of appetite (p = 0.035), drowsiness (p < 0.001), feeling sad (p = 0.031), and interference with walking (p < 0.001). In multivariable logistic regression models, shortness of breath (adjusted OR 1.15, 95% CI 1.04–1.26, p = 0.005) and drowsiness (adjusted OR 1.17, 95% CI 1.05–1.33, p = 0.008) were associated with 90-day mortality, adjusting for age, race, performance status, and cancer type. The median total MDASI score was significantly higher in patients with delirium than in those without (88, IQR 83–118 vs. 80, IQR 55–104; p < 0.001). Conclusions: Patients with advanced cancer presenting to the ED had severe symptoms, some of which were associated with shorter survival. These findings underscore the necessity of systematic symptom assessment, focusing on shortness of breath, drowsiness, fatigue, difficulty remembering, lack of appetite, feeling sad, and feeling distressed, to enhance clinical decision-making and improve the care of patients with advanced cancer. Additional longitudinal studies are needed to evaluate the improvement in symptoms and quality of life for these patients. Full article
(This article belongs to the Special Issue Symptom Burden in Cancer: Assessment and Management)
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12 pages, 1182 KiB  
Article
Using mHealth Technology to Evaluate Daily Symptom Burden among Adult Survivors of Childhood Cancer: A Feasibility Study
by Kristen E. Howell, Jessica L. Baedke, Farideh Bagherzadeh, Aaron McDonald, Paul C. Nathan, Kirsten K. Ness, Melissa M. Hudson, Gregory T. Armstrong, Yutaka Yasui and I-Chan Huang
Cancers 2024, 16(17), 2984; https://doi.org/10.3390/cancers16172984 - 27 Aug 2024
Viewed by 1113
Abstract
Background: Cancer therapies predispose survivors to a high symptom burden. This study utilized mobile health (mHealth) technology to assess the feasibility of collecting daily symptoms from adult survivors of childhood cancer to evaluate symptom fluctuation and associations with future health-related quality-of-life (HRQOL). Methods: [...] Read more.
Background: Cancer therapies predispose survivors to a high symptom burden. This study utilized mobile health (mHealth) technology to assess the feasibility of collecting daily symptoms from adult survivors of childhood cancer to evaluate symptom fluctuation and associations with future health-related quality-of-life (HRQOL). Methods: This prospective study used an mHealth platform to distribute a 20-item cancer-related symptom survey (5 consecutive days each month) and an HRQOL survey (the day after the symptom survey) over 3 consecutive months to participants from the Childhood Cancer Survivor Study. These surveys comprised a PROMIS-29 Profile and Neuro-QOL assessed HRQOL. Daily symptom burden was calculated by summing the severity (mild, moderate, or severe) of 20 symptoms. Univariate linear mixed-effects models were used to analyze total, person-to-person, day-to-day, and month-to-month variability for the burden of 20 individual symptoms. Multivariable linear regression was used to analyze the association between daily symptom burden in the first month and HRQOL in the third month, adjusted for covariates. Results: Out of the 60 survivors invited, 41 participated in this study (68% enrollment rate); 83% reported their symptoms ≥3 times and 95% reported HRQOL in each study week across 3 months. Variability of daily symptom burden differed from person-to-person (74%), day-to-day (18%), and month-to-month (8%). Higher first-month symptom burden was associated with poorer HRQOL related to anxiety (regression coefficient: 6.56; 95% CI: 4.10–9.02), depression (6.32; 95% CI: 3.18–9.47), fatigue (7.93; 95% CI: 5.11–10.80), sleep (6.07; 95% CI: 3.43–8.70), pain (5.16; 95% CI: 2.11–8.22), and cognitive function (–6.89; 95% CI: –10.00 to –3.79) in the third month. Conclusions: Daily assessment revealed fluctuations in symptomology, and higher symptom burden was associated with poorer HRQOL in the future. Utilizing mHealth technology for daily symptom assessment improves our understanding of symptom dynamics and sources of variability. Full article
(This article belongs to the Special Issue Symptom Burden in Cancer: Assessment and Management)
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