Yufen Lin, PhD student, and her faculty sponsor Chip Bailey, associate professor, have received an award for Lin's American Cancer Society proposal entitled: “Multiple Co-occurring Symptoms in Patients with Gastrointestinal Cancers." This award is for $30,000 for a two-year period starting September 1.

Background

The American Cancer Society estimates that 328,030 new cases of gastrointestinal (GI) cancers will be diagnosed in 2019 and approximately 165,460 patients will die from their disease. Patients with GI cancers experience numerous distressing symptoms associated with their disease and treatment. On average, 10 to 15 of these symptoms occur concurrently during chemotherapy (CTX), including abdominal pain, nausea, weight loss, dysphagia, fatigue, sleep disturbance, and depression. When multiple co-occurring symptoms are undertreated, they can significantly decrease patients’ functional status, treatment adherence, quality of life (QOL), and overall survival. To date, most studies have focused on individual symptoms in patients with GI cancers, therefore, little is known about multiple co-occurring symptoms in these patients.

Objective

The purpose of this study is to identify subgroups of patients based on their distinct symptom experiences with multiple co-occurring symptoms and evaluate differences among these subgroups in phenotypic characteristics and QOL outcomes.

Specific aims

Aim 1: Identify the subgroups of patients with GI cancers based on their distinct symptom experiences (symptom occurrence) with multiple co-occurring symptoms. Hypothesis: Four distinct subgroups (latent classes) will be identified: all low, moderate physical and low psychological, moderate physical and high psychological, and all high. Aim 2: Determine whether the subgroups differ on a number of phenotypic (e.g., demographics, clinical) characteristics. Hypothesis: Older age, female gender, lower education, worse comorbidity profile, and having metastatic disease will be associated with the “all high” subgroup. Aim 3: Evaluate the differences in QOL outcomes among these subgroups. Hypothesis: Patients in the all high distinct subgroup will have the worst QOL scores.

Study design

This study is part of a prospective longitudinal study of symptom clusters in oncology outpatients who received chemotherapy (R01 CA134900). For this study, only patients with GI cancers are included (n=404). Latent class analysis will be used to identify subgroups of patients (i.e., latent classes) with distinct symptom experiences based on patient’s ratings of symptom occurrence (Aim 1). The differences in demographic and clinical characteristics and QOL outcomes, among the subgroups, will be evaluated using analyses of variance, Kruskal-Wallis, and Chi-squared analyses (Aim 2 and Aim 3). Cancer relevance: The findings from this study will identify the phenotypes of multiple co-occurring symptoms in patients with GI cancers. To our knowledge, this will be the first study to identify the subgroups and evaluate differences among these subgroups in phenotypic characteristics and QOL outcomes in patients with GI cancers. Our long-term goal is to develop tailored self-management interventions that can be used to reduce symptom burden, improve QOL, and possibly prevent the symptom toxicities associated with cancer and its treatment.