Distinct Trajectories of Symptom Burden Development in Patients With Stage IV Cancer

CONTEXT: Patients with stage IV cancer often experience multiple, sequential symptoms that can co-exist, interact and negatively impact health-related quality of life. Currently, it is challenging to identify patients at risk of developing high symptom burden. OBJECTIVES: To identify subgroups of patients with distinct symptom burden trajectories and characteristics of patients at risk of developing high symptom burden. METHODS: We pooled data from two prospective studies, using the EORTC QLQ-C30 to assess symptom burden at baseline, three, six, nine, and 12 months. We identified subgroups with distinct symptom burden trajectories using group-based multi-trajectory modelling. We assessed which sociodemographic and clinical characteristics were predictive for high symptom burden trajectories using multivariable logistic regression analysis. RESULTS: In 841 patients (mean age 65 years [standard deviation 9.8], 50% male), we identified five subgroups within the symptom scales and six subgroups within the functioning scales. 29% of patients were at risk of both increased symptoms and low functioning, indicating high symptom burden. Younger age, lower educational level, ≥1 comorbidity and hospital admission in the past month were predictive of high symptom burden. CONCLUSION: Approximately one-third of patients with stage IV cancer are at risk of high symptom burden. Our study identified distinct patient profiles that can be used to proactively identify those at increased risk. Timely identification of these patients using symptom monitoring allows clinicians to optimize timely and adequate treatment of coexisting symptoms. These findings highlight the importance of personalized approaches in improving health-related quality of life for patients with advanced cancer.