Prevalence of concurrent severe self-reported late symptoms and functional limitations in cancer survivors: a cross-sectional study of sociodemographic, clinical, and lifestyle associations

PURPOSE: This population-based study investigated the prevalence of concurrent severe symptoms and functional limitations among Danish cancer survivors, examining associations with sociodemographic, clinical, and lifestyle factors.

METHODS: We conducted a cross-sectional analysis using data from the nationwide SEQUEL questionnaire study (2022), including 40,766 survivors 2- to 12-year post-diagnosis (2010-2019). Up to 21 symptoms, five functioning domains, and sexual satisfaction were assessed using validated instruments (EORTC QLQ-C30, EORTC Item Library, QLQ-SHQ22, GAD-7, PHQ-9). Data were obtained from Danish registries, clinical databases, and self-report. Symptoms and functional limitations were categorized as severe using predefined thresholds. Ordinal logistic regression models examined factors associated with concurrent symptoms.

RESULTS: Mean symptom count was 4.1 for women (range 0-21, SD 3.19) and 3.3 for men (range 0-20, SD 2.72), with 25% of women and 16% of men experiencing ≥ 5 concurrent severe symptoms. Lung cancer survivors reported the highest symptom burden. Factors significantly associated with concurrent symptoms included short education, lower income, living alone, multiple comorbidities (CCI ≥ 2), advanced disease, palliative treatment, current smoking, and higher BMI, with ORs ranging from 1.29-2.19 (women) and 1.23-2.25 (men). Impaired functioning showed similar associations.

CONCLUSION: Concurrent late symptoms are common among cancer survivors, indicating complex health issues varying by cancer type and clinical characteristics, with clear socioeconomic disparities and lifestyle associations. These findings highlight subgroups who may benefit from interventions targeting multiple symptoms and underscore the importance of addressing social determinants and lifestyle factors in survivorship care.