Characterizing Pain, Fatigue and Distress Symptom Severity and Classes in Symptomatic Early-Onset Colorectal Cancer Patients
Kelly A. Hyland, Hannah M. Fisher, Joseph G. Winger, Donna Niedzwiecki, Zihan Wan, Grace H. Amaden, Sara J. Hogan, Allison K. Diachina, Hope E. Uronis, Francis J. Keefe, Tamara J. Somers, Sarah A. KelleherIntroduction
The incidence of early-onset colorectal cancer (EO-CRC) is steadily rising, although the cause is unclear. CRC patients often experience high symptom burden, including pain, fatigue, and distress, but symptom presentations in EO-CRC patients are poorly understood. The aim of the current study was to characterize baseline symptoms (pain, fatigue, distress) and symptom classes in a sample of symptomatic EO-CRC patients.
Methods
Analysis of cross-sectional baseline data from patients enrolled in a mHealth symptom management randomized controlled trial. Participants were 18-50 years old with a CRC diagnosis (stage I-IV) in the last 3 years and self-reported severity of ≥3/10 on at least 2 symptoms (pain, fatigue, distress). Participants completed measures assessing pain (BPI), fatigue (PROMIS), and distress (BSI). Latent class analysis was used to examine symptom classes and moderating variables [sex, cancer stage, site of disease, treatment in past 7 days, body mass index (BMI), years since diagnosis].
Results
Participants (N=165, M age=42.2 years (SD=5.7), 53% female, 70% White, 48% Stage IV disease, M time since diagnosis=1 year), on average, endorsed mild pain (M=3.0, SD=2.1), high fatigue (M=55.9, SD=7.1), and moderate distress (M=58.2, SD=8.8). A two-class latent class model was fit. Classes were identified as: low pain, moderate fatigue, moderate distress (Class 1; 60%); moderate pain, high fatigue, high distress (Class 2, 40%). Probability profiles differed by sex and BMI, but not by cancer stage, site of disease (colon; rectum), recent active treatment, or years from diagnosis.
Conclusion
Symptomatic EO-CRC patients enrolled in a symptom management trial experience elevated fatigue, distress, and to a lesser extent, pain. Symptoms presented in two distinct classes characterized by overall low-moderate and moderate-high symptom burden. Sex-based and BMI differences in class membership exist; findings warrant replication. Findings support developing multi-symptom interventions tailored to the needs of EO-CRC patients.