title: All's well that ends well? Quality of life and physical symptom clusters in long-term cancer survivors across cancer types.
abstract: BACKGROUND
  Little is known about the presentation of multiple concurrent symptoms (symptom clusters) in long-term cancer survivors, with few studies adequately powered to compare quality of life (QoL) and symptom presentation by cancer type.
  
  
  OBJECTIVE
  This research aimed to 1) assess patient-reported QoL and 2) identify clusters of cancer-related physical symptoms by cancer type among long-term breast, prostate, colorectal, and melanoma cancer survivors.
  
  
  METHODS
  A population-based cross-sectional sample of 863 adult cancer survivors five to six years post-diagnosis completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), assessing global QoL and frequency of presentation of cancer-related physical symptoms.
  
  
  RESULTS
  Long-term survivors reported higher levels of global QoL than 1) the general population (age-adjusted mean=79.4 vs. 71.1, small clinical difference) and 2) cancer patients early in the care trajectory (age-adjusted mean=77.1 vs. 61.3, moderate clinical difference). The majority (71%) did not report any cancer-related physical symptoms; 18% reported multiple (two or more) symptoms in the past month. Factor analysis found that cognitive functioning, fatigue, insomnia, pain, dyspnea, appetite loss, constipation, diarrhea, nausea, and vomiting formed a cluster (α=0.48). No symptom clusters were identified that were specific to just one cancer type. However, individual symptoms (including diarrhea, pain, constipation, and insomnia) modestly discriminated between cancer types.
  
  
  CONCLUSIONS
  Contrary to expectations, no symptom clusters specific to one type of cancer were identified and survivors reported few cancer-related symptoms and high QoL. These results convey a strong "good news" message, providing health professionals with a sound foundation for making encouraging predictions about their patients' long-term physical recovery after cancer. Cancer patients also will welcome the news that only a minority of five-year survivors experience long-term and late effects.
authors.affiliation: Centre for Health Research & Psycho-oncology (CHeRP), Cancer Council NSW, University of Newcastle, Callaghan, New South Wales, Australia. Alison.Zucca@newcastle.edu.au
authors.forename: Alison C
authors.initials: AC
authors.lastname: Zucca
authors.forename: Allison W
authors.initials: AW
authors.lastname: Boyes
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Linden
authors.forename: Afaf
authors.initials: A
authors.lastname: Girgis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D015897:Comorbidity; D005221:Fatigue / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000453:epidemiology*; D009369:Neoplasms / Q000453:epidemiology*; D010146:Pain / Q000453:epidemiology*; D015995:Prevalence; D011788:Quality of Life; D018570:Risk Assessment; D012307:Risk Factors; D017741:Survivors / Q000706:statistics & numerical data*; D055815:Young Adult