title: Symptom burden among cancer survivors: impact of age and comorbidity.
abstract: BACKGROUND
  Previous research among specific cancer populations has shown high but variable symptom burden; however, very little is known about its extent and pattern among the entire population of US cancer survivors, which is more clinically relevant to primary care physicians.
  
  
  METHODS
  To determine the prevalence of ongoing symptom burden among cancer survivors and compare it with the general population without cancer, we analyzed data from the 2002 National Health Interview Survey, which included 1,904 cancer survivors and 29,092 controls. Main outcome measures included self-reported ongoing pain, psychological distress, and insomnia. Multivariate logistic regression models were used to adjust for confounders and test for interactions.
  
  
  RESULTS
  The rates of ongoing pain, psychological distress, and insomnia among cancer survivors were 34%, 26%, and 30%, respectively, and were significantly higher (all P<.001) than controls without a history of cancer (18%, 16%, and 17%). Compared with controls in the same age groups, younger survivors (younger than 50) were much more likely to report ongoing symptoms than older survivors (older than 64); adjusted odds ratios were 2.96 and 1.36 for pain in the respective age groups (P<.001). Comorbidities also interact with cancer status and contribute to a marked increase in reports of ongoing symptom burden among cancer survivors, with a greater number of comorbidities leading to greater degree of symptom burden in a dose-dependent manner (P<.001).
  
  
  CONCLUSIONS
  The symptom burden among cancer survivors on a population level is substantial and can be impacted by other comorbidities. Thus, engaging primary care physicians in the design, testing, and implementation of effective interventions is important to reduce the symptom burden among cancer survivors.
authors.affiliation: Department of Family Medicine and Community Health, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia 19104, USA. maoj@uphs.upenn.edu
authors.forename: Jun J
authors.initials: JJ
authors.lastname: Mao
authors.forename: Katrina
authors.initials: K
authors.lastname: Armstrong
authors.forename: Marjorie A
authors.initials: MA
authors.lastname: Bowman
authors.forename: Sharon X
authors.initials: SX
authors.lastname: Xie
authors.forename: Rachel
authors.initials: R
authors.lastname: Kadakia
authors.forename: John T
authors.initials: JT
authors.lastname: Farrar
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D016022:Case-Control Studies; D015897:Comorbidity; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology / Q000534:rehabilitation*; D010146:Pain / Q000453:epidemiology*; D015995:Prevalence; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology*; D013315:Stress, Psychological / Q000453:epidemiology*; D017741:Survivors / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology