The goal of this study was to identify the symptoms of patients with advanced cancer. One hundred consecutive patients referred to the Palliative Care Service at the Cleveland Clinic Foundation were studied using a standard tool that included questions on 38 specific symptoms. The most common symptoms were pain, weight loss, and anorexia. Significant findings also included that women had more frequent and severe gastrointestinal complaints than men. These do not appear to be related to specific cancer primary sites.

We describe the symptoms, physical findings, treatment interventions, risk factors, and length of survival in persons with pancreatic cancer referred to a palliative care service (PCS) in a tertiary care facility. Data were collected prospectively over a 2-yr period using a standard clinical assessment tool in 39 patients with unresectable pancreatic cancer. Common symptoms include pain (82%), anorexia (64%), early satiety (62%), xerostomia and sleep problems (both 54%), and weight loss (51%). Analyzed retrospectively, 82% had at least one known risk factor for the development of pancreatic cancer. Twenty-five people presented to the PCS within 1 mo of diagnosis; in this group, length of survival was analyzed according to the presence of specific symptoms, and a significant inverse relationship between the presence of dyspnea and length of survival was found. As there is no effective treatment for surgically unresectable pancreatic cancer, palliation of common symptoms should be the primary emphasis of therapy.

Lung cancer is the most common cancer and kills more people than any other malignancy. We describe the symptoms experienced in persons with lung cancer. Data on 100 consecutive patients were collected prospectively using a standard assessment tool. The median number of symptoms was nine. The most common and severe symptoms were pain (86), dyspnoea (70) and anorexia (68). There were no differences between males and females. Males aged 64 and under had higher incidences of easy fatigue, taste changes and sleep problems. Men over 64 had higher incidences of cough and >10% weight loss. Although there was a general increase in the number of symptoms as the performance status worsened, those with the poorest performance status reported the fewest symptoms. Since there is little effective treatment for most lung cancers, clinical management, research and resources should be directed by, and targeted to, palliative care.

Communication between patient/family and the professional medical team is a priority for a service working with advanced cancer. Family conferences including all those persons involved in the patient's care have been established in a busy palliative care service to facilitate open communication. We report on the questions asked by families during 50 consecutive family conferences, during which the questions were recorded verbatim and categorized. Families want detailed knowledge of the extent of the patient's illness and life expectancy. We make recommendations about how best to conduct these conferences, based on these data and our own experience.

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