Changes in the Occurrence, Severity, and Distress of Symptoms in Patients With Gastrointestinal Cancers Receiving Chemotherapy

Ilufredo Y. Tantoy, Bruce A. Cooper, Anand Dhruva, Janine Cataldo, Steven M. Paul, Yvette P. Conley, Marilyn Hammer, Fay Wright, Laura B. Dunn, Jon D. Levine, Christine Miaskowski

Research output: Contribution to journalArticle


Context: Studies on multiple dimensions of the symptom experience of patients with gastrointestinal cancers are extremely limited. Objective: Purpose was to evaluate for changes over time in the occurrence, severity, and distress of seven common symptoms in these patients. Methods: Patients completed Memorial Symptom Assessment Scale, six times over two cycles of chemotherapy (CTX). Changes over time in occurrence, severity, and distress of pain, lack of energy, nausea, feeling drowsy, difficulty sleeping, and change in the way food tastes were evaluated using multilevel regression analyses. In the conditional models, effects of treatment group (i.e., with or without targeted therapy), age, number of metastatic sites, time from cancer diagnosis, number of prior cancer treatments, cancer diagnosis, and CTX regimen on enrollment levels, as well as the trajectories of symptom occurrence, severity, and distress were evaluated. Results: Although the occurrence rates for pain, lack of energy, feeling drowsy, difficulty sleeping, and change in the way food tastes declined over the two cycles of CTX, nausea and numbness/tingling in hands/feet had more complex patterns of occurrence. Severity and distress ratings for the seven symptoms varied across the two cycles of CTX. Conclusions: Demographic and clinical characteristics associated with differences in enrollment levels as well as changes over time in occurrence, severity, and distress of these seven common symptoms were highly variable. These findings can be used to identify patients who are at higher risk for more severe and distressing symptoms during CTX and to enable the initiation of preemptive symptom management interventions.

Original languageEnglish (US)
Pages (from-to)808-834
Number of pages27
JournalJournal of Pain and Symptom Management
Issue number3
StatePublished - Mar 2018



  • Gastrointestinal cancer
  • chemotherapy
  • distress
  • fatigue
  • feeling drowsy
  • pain
  • severity
  • sleep disturbance
  • targeted therapy
  • taste changes

ASJC Scopus subject areas

  • Nursing(all)
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this