281P - Cancer-related symptoms as mediators between treatment and functional capacity in adolescents and young adults (AYAs) with cancer

Background

The functional capacity of AYA patients is often disrupted by the intersection between the cancer experience and important early-life transitions. This study aimed to identify clinical/treatment risk factors of functional capacity in Chinese AYA cancer patients, and examine the mediatory effects of cancer-related symptoms.

Methods

We recruited AYAs (15 to 39 years old) diagnosed with cancer from a tertiary hospital in Hong Kong. They completed the Life Functioning Questionnaire to report their functional capacity in performing work/school and home activities. The predictive characteristics are symptom burden (Rotterdam Symptom Checklist), cognitive symptoms (CCSS-Neurocognitive Function Questionnaire) and psychological symptoms (Brief Symptom Inventory-18). General linear models were used to identify predictive characteristics of functional capacity, adjusted for age and sex. Mediation analysis was performed to examine indirect effects of symptoms on functional outcomes.

Results

This analysis included 120 AYA cancer patients (45.8% male; mean [SD] age 32.0 [5.9] years). Patients with breast cancer (16.7%) reported more functional disruption at work (Est=5.28, SE=1.18, P<0.001) than patients with hematological malignancies, sarcomas, and other solid tumors. Patients treated with surgery (Est= -1.11, SE=0.44, P =0.014) and chemotherapy (Est =1.05, SE=0.47, P =0.027) reported poor home functioning. Physical symptoms (Est= 0.09, SE=0.03, P <0.001), psychological symptoms (Est=0.10, SE=0.03, P =0.001) and cognitive symptoms (Est= 0.36, SE=0.09, P <0.001) were significantly associated with poorer work functioning. Mediation analyses showed that physical symptoms (ß= 1.01, SE= 0.39, P <0.001) and cognitive symptoms (ß= 0.87, SE= 0.36, P <0.001) are strong mediators between chemotherapy and poor work functioning. Psychological symptoms mediated the relationship between chemotherapy and home functioning (ß= 0.87, SE= 0.29, P <0.001).

Conclusions

Cancer-related symptoms are potential mediators between treatment and poor functional capacity in AYAs with cancer. Our work supports the importance of timely and effective management of symptoms during the cancer care continuum.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Health and Medical Research Fund by the Food and Health Bureau, The Government of the Hong Kong Special Administrative Region.

Disclosure

H.H.F. Loong: Financial Interests, Institutional, Invited Speaker: Boehringer-Ingelheim, MSD; Financial Interests, Personal, Invited Speaker: Eli Lilly, Illumina, Bayer, Guardant Health; Financial Interests, Personal, Advisory Board: Novartis, Takeda. All other authors have declared no conflicts of interest.