Fatigue, finances, and pain: Sources of distress in kidney cancer

In total, about 20% of patients with newly diagnosed metastatic renal cell carcinoma (mRCC) experience high levels of distress secondary to a range of issues, according to a new study published in Palliative & Supportive Care.

“Efforts have long been underway to regularly screen and effectively manage distress as an important component of patient care,” wrote the authors, led by Cristiane Decat Bergerot, PhD, Department of Medical Oncology & Experimental Therapeutics, City of Hope National Medical Center, Duarte, CA. “There have been attempts to identify whether an association between distress and survival exists, although not specifically in mRCC patients.”

Although an association between cancer and distress makes logical sense, distress is multifactorial. The dearth of research on the topic has yielded mixed results, possibly due to complexities in cancer type, disease stage, and patient factors.

In the current study, researchers intended to analyze the rates and types of distress in patients with mRCC, as well as the dynamic between distress and survival.

In this retrospective study, investigators gathered clinical and pathological information representing 102 adult mRCC patients (71.6% men; 70.6% married; 73.5% white) treated at a single cancer center. The team categorized patients as high-, intermediate-, or low-disease risk, with 59.8% categorized as intermediate-disease risk.

During the first or second patient oncology visit, the researchers administered an electronic survey lasting between 10 and 15 minutes to gauge biopsychosocial problem-related stress. The assessment comprised 22 core items on a 5-point Likert scale (5=very severe problem; ≥3=high distress), indicating physical, practical, functional, and emotional measures.

The team statistically determined survival curves in high- vs low-distress mRCC patients. The team performed all other tests of association between distress and survival via Cox proportional hazard models and controlled for age, gender, marital status, and ethnicity.

Dr. Bergerot and colleagues found that the median overall survival (OS) was 43.7 months (95% CI: 35.5, 52.5) for the overall cohort; 20.0 months (95% CI: 16.0, 55.9) in patients with high distress; and 45.8 months (CI 95%: 36.1, 55.5) in patients with low distress (P=0.81). After sensitivity analysis for confounders, they saw a trend towards decreased OS in patients with high distress vs low distress.

The following issues resulted in the highest distress:

• Fatigue (48.0%)
• Finances (43.2%)
• Pain (39.5%)
• Sleeping (35.6%)
• How family will cope (35.6%)
• Walking/climbing stairs (31.6%)
• Adverse effects of treatment (27.9%)
• Transportation (26.7%)

The researchers noted that about 50% of patients complained of fatigue, but between 10% and 15% experienced grade 3 to grade 4 fatigue. “This implies either disabling toxicity or toxicity precluding activities of daily living,” they wrote. “Several strategies can be implemented to address fatigue, including exercise programs and pharmacologic strategies (eg, modafinil).”

The team also points to “financial toxicity,” which is exacerbated by the high costs of treatment, often in the form of high co-pays. “Addressing these needs early may circumvent distress from financial concerns during treatment.”

This study did have limitations, in that it was performed at a solitary institution. Also, the investigators based their results on one, brief survey that they administered early during treatment.

“Based on data from a relatively large sample of patients,” concluded the researchers, “this study provides the first specific insights into the potential impact of biopsychosocial distress and outcomes among patients with mRCC.”

To read more about this study, click here.