Approximately 30% to 50% of patients with early-stage breast or colon cancer do not receive clinician advice regarding management of pain, fatigue, and emotional distress, according to results of a patient survey. The findings of this study were published in the Journal of Clinical Oncology.

Treatment of early-stage cancer of the breast or colon often involves the use of multimodality therapy, frequently including surgery, chemotherapy, and systemic targeted therapy, and in some cases, radiation therapy. Hence, treatment-related physical and psychosocial symptoms — both of which are experienced during and following cancer treatment — can be considerable and are associated with poor adherence to treatment and decreased quality of life.

Pain, fatigue, and emotional distress are 3 common debilitating symptoms experienced by patients with cancer, and inadequate management of these symptoms can be related to patient (failure to report), clinician (failure to assess or address), and institutional barriers.

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This study used patient-reported outcomes (PROs) to evaluate the prevalence and predictors of these 3 cancer-related symptoms, as well as to assess patient perceptions regarding the care they received in the management of these symptoms.

The study was conducted at 17 hospital-based community cancer centers participating in the National Cancer Institute (NCI) Community Cancer Centers Program. Eligible patients were those who were at least 21 years old, had stage I to III breast or colon cancer, and were included in the Rapid Quality Reporting System registry from the Commission on Cancer.

Of the 4175 patients who were identified as eligible for the study between February 2011 and January 2013 and were sent a study packet including survey questionnaire and instructions, 2487 (59.6%) completed the survey. Most of these patients were women with breast cancer (82.4%) who identified as non-Hispanic white (84.3%).

The survey included 4 questions that study participants were asked to answer separately for each of the 3 identified symptoms occurring within the last 4 to 6 months. The questions related to whether the respondent had talked with their clinician about the symptom; whether the clinician provided advice regarding management of the symptom; whether the patient had been bothered by the symptom; and, for those reporting being bothered by the symptom within the last 6 months, whether the clinician had provided the help wanted.

Among those who completed the survey, 76.2% reported having talked with their clinicians about pain, 78.0% about fatigue, and 59.2% about distress. The percentages of patients who reported having received clinician advice regarding these symptoms were 70.0% (pain), 60.8% (fatigue), and 54.3% (distress). The reported prevalence of pain, fatigue, and distress were 61.2%, 73.9%, and 46.4%, respectively. Among the subgroup of patients reporting at least 1 of these symptoms, the percentages of those who agreed that they received the help they wanted were 57.5%, 40.1%, and 45.5%, respectively.

Another important study finding was that patients who reported experiencing a symptom were much more likely to have talked with and received advice on symptom management from their clinician (talked about pain, odds ratio[OR] 10.71; received advice, OR 4.90).

The study authors commented that despite symptom care guidelines that include recommendations for clinician assessment for these symptoms in all patients with cancer, this result suggests that that patients with these symptoms may be the ones initiating discussions about them.

Other study findings were that older patients or those who underwent cancer treatment less recently were less likely to report experiencing pain, fatigue, or distress to their clinicians, despite reporting a relatively high prevalence of these symptoms.

“Appropriate use of PROs that measure cancer symptoms and patients’ perceptions of their care can improve our understanding through research, performance measurement, and clinical assessment,” concluded the study authors.


Smith TG, Troeschel AN, Castro KM, et al. Perceptions of patients with breast and colon cancer of the management of cancer-related pain, fatigue, and emotional distress in community oncology [published online May 17, 2019]. J Clin Oncol. doi: 10.1200/JCO.18.01579