Physical symptoms from cancer can cause disability

Cancer patients and survivors experiencing pain or depression also often have physical symptoms that can cause disability, according to a new study. Such symptoms include dizziness, back pain and fatigue.

Primary care physicians can improve the quality of life for such patients by promptly identifying and treating these symptoms, said lead study author Kurt Kroenke, MD.

"Primary care doctors see a lot of cancer survivors ... and this is a population that's at risk of having [these physical] symptoms," said Dr. Kroenke, chancellor's professor of medicine at Indiana University School of Medicine and a Regenstrief Institute investigator. The Regenstrief Institute aims to improve health through research that enhances the quality and cost-effectiveness of care.

"Residual symptoms from cancer can be a cause for a lot of the disability and suffering patients have. Patients need to know that, and doctors should be aware of it," he said.

For the study, in the Oct. 11 Archives of Internal Medicine, researchers examined data on 405 adults 23 and older who enrolled in the Indiana Cancer Patient and Depression trial between March 1, 2006, and Aug. 31, 2008. Enrollees had various types of cancer and were in different phases of the disease, from newly diagnosed to disease-free. All had depression, pain or both.

Researchers analyzed the presence and severity of 22 physical symptoms associated with cancer in the participants. They found that at least one patient had each of the studied symptoms. Fifteen symptoms were reported by more than half of the patients (link).

The most common symptoms were fatigue, insomnia, pain in the limbs or joints, back pain and impaired memory.

Nearly 60% of patients had at least 14 disability days in a four-week period because of their symptoms. The study defined a disability day as having to stay in bed or reduce usual activities by at least 50% because of physical or emotional problems.

The burden of the symptoms was similar for all patients regardless of their type of cancer or the phase of their disease.

Dr. Kroenke suggests that primary care physicians ask their cancer patients, and those who no longer have the disease, about bothersome physical symptoms. To save time, he said, patients could fill out a symptom questionnaire before their office visit.

"Physicians should recognize that [these patients] are a higher-risk population," he said.