{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T02:46:22Z","timestamp":1784601982936,"version":"3.55.0"},"reference-count":50,"publisher":"Wiley","issue":"24","license":[{"start":{"date-parts":[[2019,9,10]],"date-time":"2019-09-10T00:00:00Z","timestamp":1568073600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["CA151692"],"award-info":[{"award-number":["CA151692"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["CA168690"],"award-info":[{"award-number":["CA168690"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2019,12,15]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Although multiple co\u2010occurring symptoms are a significant problem for cancer survivors, to the authors' knowledge little is known regarding the phenotypic characteristics associated with a higher symptom burden. The objectives of the current study were to evaluate the occurrence, severity, and distress associated with 32 symptoms and examine the phenotypic and stress characteristics associated with a higher symptom burden.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 623 cancer survivors completed a demographic questionnaire, as well as measures of functional status, comorbidity, and global (Perceived Stress Scale) and cancer\u2010related (Impact of Event Scale\u2013Revised) stress. The Memorial Symptom Assessment Scale was used to evaluate symptom burden. Multiple linear regression analysis was used to determine the phenotypic characteristics associated with a higher symptom burden.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The mean number of symptoms was 9.1 (\u00b15.2). The most common, severe, and distressing symptoms were lack of energy, problems with sexual interest\/activity, and hair loss, respectively. Poorer functional status, a higher level of comorbidity, and a history of smoking as well as higher Perceived Stress Scale and Impact of Event Scale\u2013Revised scores were associated with a higher symptom burden. The overall model explained approximately 45.6% of the variance in symptom burden.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Although cancer survivors report a high number of co\u2010occurring symptoms of moderate severity and distress, in the current study, no disease or treatment characteristics were found to be associated with a higher symptom burden. Clinicians need to assess for general and disease\u2010specific stressors and provide referrals for stress management interventions. Future studies need to examine the longitudinal relationships among symptom burden, functional status, and level of comorbidity, as well as the mechanisms that underlie the associations between stress and symptom burden.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.32477","type":"journal-article","created":{"date-parts":[[2019,9,10]],"date-time":"2019-09-10T10:40:04Z","timestamp":1568112004000},"page":"4509-4515","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":61,"title":["Perceived stress is associated with a higher symptom burden in cancer survivors"],"prefix":"10.1002","volume":"125","author":[{"given":"Melissa","family":"Mazor","sequence":"first","affiliation":[{"name":"Department of Physiological Nursing, School of Nursing University of California at San Francisco San Francisco California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven M.","family":"Paul","sequence":"additional","affiliation":[{"name":"Department of Physiological Nursing, School of Nursing University of California at San Francisco San Francisco California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret A.","family":"Chesney","sequence":"additional","affiliation":[{"name":"Department of Medicine, School of Medicine University of California at San Francisco San Francisco California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lee\u2010May","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Medicine, School of Medicine University of California at San Francisco San Francisco California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Betty","family":"Smoot","sequence":"additional","affiliation":[{"name":"Department of Medicine, School of Medicine University of California at San Francisco San Francisco California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly","family":"Topp","sequence":"additional","affiliation":[{"name":"Department of Medicine, School of Medicine University of California at San Francisco San Francisco California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yvette P.","family":"Conley","sequence":"additional","affiliation":[{"name":"Department of Health Promotion and Development, School of Nursing University of Pittsburgh Pittsburgh Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jon D.","family":"Levine","sequence":"additional","affiliation":[{"name":"Department of Medicine, School of Medicine University of California at San Francisco San Francisco California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5170-2027","authenticated-orcid":false,"given":"Christine","family":"Miaskowski","sequence":"additional","affiliation":[{"name":"Department of Physiological Nursing, School of Nursing University of California at San Francisco San Francisco California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,9,10]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21565"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/NCC.0000000000000135"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.26146"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.2190\/PM.40.2.c"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11764-017-0662-8"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(16)30573-3"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.suponc.2011.11.001"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11764-009-0100-7"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1188\/13.ONF.35-42"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djy232"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10549-017-4290-9"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.2147\/BCTT.S111101"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-12-800951-2.00001-7"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbi.2017.02.006"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/1744806916646783"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2018.02.021"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2016.12.342"},{"key":"e_1_2_8_19_1","volume-title":"Performance Scale","author":"Karnofsky D","year":"1977"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(194811)1:4<634::AID-CNCR2820010410>3.0.CO;2-L"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.10993"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.2307\/2136404"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-013-2038-6"},{"key":"e_1_2_8_24_1","volume-title":"The Impact of Event Scale\u2010Revised","author":"Weiss DS","year":"1997"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006842-197905000-00004"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2003.07.010"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2015.00118"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.180.3.205"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/0959-8049(94)90182-1"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00435383"},{"key":"e_1_2_8_31_1","first-page":"260","article-title":"The measurement of musculoskeletal pain intensity: a comparison of four methods","volume":"28","author":"Gallasch CH","year":"2007","journal-title":"Rev Gaucha Enferm"},{"key":"e_1_2_8_32_1","volume-title":"IBM SPSS for Windows","author":"SPSS Inc","year":"2015"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3959(94)00178-H"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-017-3593-z"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1188\/11.ONF.672-680"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2000.18.4.743"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2013.52.4629"},{"key":"e_1_2_8_38_1","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdt506"},{"key":"e_1_2_8_39_1","doi-asserted-by":"publisher","DOI":"10.1002\/pon.4230"},{"key":"e_1_2_8_40_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-014-2513-8"},{"issue":"5","key":"e_1_2_8_41_1","article-title":"Financial toxicity of cancer care: it's time to intervene","volume":"108","author":"Zafar SY","year":"2016","journal-title":"J Natl Cancer Inst"},{"key":"e_1_2_8_42_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291717000150"},{"key":"e_1_2_8_43_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10880-012-9308-1"},{"key":"e_1_2_8_44_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10865-017-9855-x"},{"key":"e_1_2_8_45_1","doi-asserted-by":"publisher","DOI":"10.7314\/APJCP.2015.16.2.641"},{"key":"e_1_2_8_46_1","doi-asserted-by":"publisher","DOI":"10.1093\/abm\/kax004"},{"key":"e_1_2_8_47_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.30801"},{"key":"e_1_2_8_48_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.15045"},{"key":"e_1_2_8_49_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.27656"},{"key":"e_1_2_8_50_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2017.05.007"},{"key":"e_1_2_8_51_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.soncn.2016.08.002"}],"container-title":["Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cncr.32477","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/cncr.32477","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cncr.32477","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T16:52:50Z","timestamp":1760287970000},"score":1,"resource":{"primary":{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/10.1002\/cncr.32477"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,9,10]]},"references-count":50,"journal-issue":{"issue":"24","published-print":{"date-parts":[[2019,12,15]]}},"alternative-id":["10.1002\/cncr.32477"],"URL":"https:\/\/doi.org\/10.1002\/cncr.32477","archive":["Portico"],"relation":{},"ISSN":["0008-543X","1097-0142"],"issn-type":[{"value":"0008-543X","type":"print"},{"value":"1097-0142","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,9,10]]},"assertion":[{"value":"2019-06-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-07-30","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-09-10","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}