Symptom clusters in patients with advanced cancers

Cheung, Winson Y.; Le, Lisa W.; Zimmermann, Camilla

doi:10.1007/s00520-009-0577-7

Cited by 142 publications

(140 citation statements)

References 41 publications

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“…Comparing our results to studies that specifically report ESAS scores from a palliative care unit or clinic, 26,27,[31][32][33][34][35][36][37][38] the symptom prevalence and symptom scores from these palliative patients are consistently higher than in our study. For example, in a study of 1296 patients attending a palliative radiation oncology outpatient clinic, 26 the median symptom score was 5 for fatigue, 2 for dyspnea, 3 for pain, and 2 for depression compared with our results of 3, 0, 1, and 0, respectively.…”

Section: Sarcomasupporting

confidence: 56%

“…Moreover, the prevalence of fatigue and depression in our cohort is consistent with other reports. [26][27][28][29][30] The high prevalence of these symptoms represents areas for continued research and treatment to improve symptom management. Furthermore these results are important to practitioners because they focus on a defined ambulatory population, are population-based, and originate from validated symptom assessment tools.…”

Section: (0)mentioning

confidence: 99%

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Symptom burden and performance status in a population‐based cohort of ambulatory cancer patients

Barbera

Seow

Howell

et al. 2010

Cancer

196

128

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BACKGROUND. For ambulatory cancer patients, Ontario has standardized symptom and performance status assessment population-wide, using the Edmonton Symptom Assessment System (ESAS) and Palliative Performance Scale (PPS). In a broad cross-section of cancer outpatients, the authors describe the ESAS and PPS scores and their relation to patient characteristics. METHODS. This is a descriptive study using administrative healthcare data. RESULTS. The cohort included 45,118 and 23,802 patients' first ESAS and PPS, respectively. Fatigue was most prevalent (75%), and nausea least prevalent (25%) in the cohort. More than half of patients reported pain or shortness of breath; about half of those reported moderate to severe scores. Seventy-eight percent had stable performance status scores. On multivariate analysis, worse ESAS outcomes were consistently seen for women, those with comorbidity, and those with shorter survivals from assessment. Lung cancer patients had the worst burden of symptoms. CONCLUSIONS. This is the first study to report ESAS and PPS scores in a large, geographically based cohort with a full scope of cancer diagnoses, including patients seen earlier in the cancer trajectory (ie, treated for cure). In this ambulatory cancer population, the high prevalence of numerous symptoms parallels those reported in palliative populations and represents a target for improved clinical care. Differences in outcomes for subgroups require further investigation. This research sets the groundwork for future research on patient and provider outcomes using linked administrative healthcare data. Cancer 2010;116:5767-76.

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Section: Sarcomasupporting

confidence: 56%

Section: (0)mentioning

confidence: 99%

Symptom burden and performance status in a population‐based cohort of ambulatory cancer patients

Barbera

Seow

Howell

et al. 2010

Cancer

196

128

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“…PCA is statistical technique used in prior studies in patients with advanced cancer to examine the symptoms that correlate with each other to form a distinct and stable pattern, which is known as a component in the PCA model [45][46][47][48]. In 114 evaluable patients, the following three clusters accounted for 63% of the total variance: the fatigue/anorexia-cachexia/depression (FAD) cluster, the sleep/ anxiety/drowsiness (SAD) cluster, and the pain/dyspnea (PD)…”

Section: Resultsmentioning

confidence: 99%

Effects of Dexamethasone and Placebo on Symptom Clusters in Advanced Cancer Patients: A Preliminary Report

et al. 2016

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Objective. Advanced cancer patients frequently experience debilitating symptoms that occur in clusters, but few pharmacological studies have targeted symptom clusters. Our objective was to examine the effects of dexamethasone on symptom clusters in patients with advanced cancer. Methods. We reviewed the data from a previous randomized clinical trial to determine the effects of dexamethasone on cancer symptoms. Symptom clusters were identified according to baseline symptoms by using principal component analysis. Correlations and change in the severity of symptom clusters were analyzed after study treatment. Results. A total of 114 participants were included in this study. Three clusters were identified: fatigue/anorexia-cachexia/ depression (FAD), sleep/anxiety/drowsiness (SAD), and pain/dyspnea (PD). Changes in severity of FAD and PD significantly correlated over time (at baseline, day 8, and day 15). The FAD cluster was associated with significant improvement in severity at day 8 and day 15, whereas no significant change was observed with the SAD cluster or PD cluster after dexamethasone treatment. Conclusion. The results of this preliminary study suggest significant correlation over time and improvement in the FAD cluster at day 8 and day 15 after treatment with dexamethasone. These findings suggest that fatigue, anorexia-cachexia, and depression may share a common pathophysiologic basis. Further studies are needed to investigate this cluster and target anti-inflammatory therapies. The Oncologist 2016; 21:384-390Implications for Practice: Results of this preliminary study suggest that fatigue-anorexia/cachexia/depression cluster scores significantly improved in the dexamethasone treatment group as compared with placebo.These findings indicate that symptoms in the fatigue/anorexia-cachexia/depression cluster might share a common causative mechanism. Further studies are needed to validate these findings.

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“…[34][35][36][37][38][39][40][41] According to two analyses of patients with terminal cancer in varied palliative care settings, fatigue was the most frequently reported symptom, and pain, depression, and anxiety were the most distressing symptoms. 2,42 In this study, the most frequently reported symptoms were pain (58%), dyspnea (52%), constipation (45%), and fatigue (23%).…”

Section: Discussionmentioning

confidence: 99%

Impact of Combined Hospice Care on Terminal Cancer Patients

Loke

Rau

Huang

2011

Journal of Palliative Medicine

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Background: Many patients with advanced cancer will develop physical and psychological symptoms related to their disease. These symptoms are infrequently treated by conventional care. Palliative care programs have been developed to fill this gap in care. However, there are limited beds in hospice units. To allow more terminal cancer patients to receive care from a hospice team, a combined hospice care system was recently developed in Taiwan. This study is a report of our experiences with this system. Patients and Methods: From January to December 2009, terminal cancer patients who accepted consultation from a hospice team for combined hospice care were enrolled in the study. Demographic data, clinical symptoms, referring department, type of cancer, and outcome were analyzed. Results: A total of 354 terminal cancer patients in acute wards were referred to a hospice consulting team. The mean patient age was 61 years, and the proportion of males was 63.28%. After combined hospice care, there was a significant improvement in the sign rate of do-not-resuscitate (DNR) orders from 41.53% to 71.47% ( p < 0.0001), and awareness of disease prognosis from 46.05% to 57.69% ( p ¼ 0.0006). Combined hospice care also enabled 64.21% of terminal cancer patients who were not transferred to hospice ward to receive combined care by a hospice consulting team while in acute wards, thus increasing the hospice utilization of terminal cancer patients. The major symptoms presented by the patients were pain (58%), dyspnea (52%), constipation (45%), and fatigue (23%). Conclusions: Through the hospice consulting system, hospice combined care has a positive effect on the utilization of hospice care, rate of DNR signing and quality of end-of-life care for terminal cancer patients.

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Symptom clusters in patients with advanced cancers

Cited by 142 publications

References 41 publications

Symptom burden and performance status in a population‐based cohort of ambulatory cancer patients

Symptom burden and performance status in a population‐based cohort of ambulatory cancer patients

Effects of Dexamethasone and Placebo on Symptom Clusters in Advanced Cancer Patients: A Preliminary Report

Impact of Combined Hospice Care on Terminal Cancer Patients

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