The Association of Symptoms with Health Outcomes in Chronically Ill Adults

Abstract

Persons with chronic disease experience multiple symptoms. Understanding the association between these symptoms and health outcomes would facilitate a targeted approach to symptom assessment and treatment. Our objectives were to determine the association of a range of symptoms with quality of life, self-rated health, and functional status among chronically ill adults and to assess methods for evaluating the independent associations of symptoms that may be inter-related. We consecutively enrolled 226 cognitively intact, community-dwelling adults, age 60 years or older with chronic obstructive pulmonary disease, heart failure or cancer. Seven symptoms (physical discomfort, pain, fatigue, problems with appetite, feelings of depression, anxiety, shortness of breath) assessed using the Edmonton Symptom Assessment Scale were examined for their association with self-rated quality of life, self-rated health, and functional status. Principal component analysis and logistic regression revealed similar results. The latter demonstrated that physical discomfort was associated with lower self-rated health (Adjusted odds ratio 1.9; 95% confidence interval 1.2-2.9), and functional disability (Adjusted odds ratio 1.8; 95% confidence interval 1.2-2.7). Feelings of depression were associated with poorer quality of life (Adjusted odds ratio 1.7; 95% confidence interval 1.1-2.6), and shortness of breath was associated with lower self-rated health (Adjusted odds ratio 1.5; 95% confidence interval 1.1-2.0). The association between a range of symptoms and quality of life, self-rated health, and functional status differed across outcomes, but only three symptoms-physical discomfort, feelings of depression and shortness of breath-maintained their associations when multiple symptoms were examined concurrently. These findings suggest that interventions targeting these symptoms could improve several health-related outcomes.

Associations between symptoms, functioning, and perceptions of mastery with global self-rated health in patients with COPD: A cross-sectional study

“…Although the correlation coefficient between dyspnea and fatigue was only .41 in this study, other studies have reported a strong relationship between the two sensations, with some patients not being able to distinguish between the two symptoms (Janson-Bjerkelie, KohlmanCarrieri, & Hudes, 1986;Kapella, Larson, Patel, Covey, & Berry, 2006). Interestingly, a recent study of symptom clusters in patients with advanced chronic diseases showed that worse dyspnea was associated with poor health ratings even after adjusting for the effects of six other symptoms including fatigue (Walke, Byers, Gallo, Endrass, & Fried, 2007). This sample was different from ours since it was comprised of patients who had advanced COPD, congestive heart failure, and cancer, therefore, they were living with a very high symptom burden and requiring assistance with their instrumental activities of daily living.…”

A Review of the Reliability and Validity of the Edmonton Symptom Assessment System

“…More than 130 relevant articles and abstracts were identified, of which thirty-nine were primary studies published as complete peer-reviewed papers, representing 25 different institutions. Of the thirty-nine papers, thirteen were from Canada 6,11,[20][21][22][23][24][25][26][27][28][29][30] ; eight were from the United States [12][13][14]18,[31][32][33][34] ; eight were from Scandinavia (Sweden 15,[35][36][37] , Denmark [38][39] , Norway 40 , Finland 16 ); two were from Western Europe (Netherlands 41 , United Kingdom 42 ); five were from southern Europe (Switzerland 43 , Italy 17,[44][45][46] ); two were from Australia 47,48 ; and one was from Asia 49 .…”

“…The remaining six papers included other populations (patients with AIDS 13 , renal disease 24 , benign disease 29 , and cardiorespiratory diseases 18,22,34 ). Sample sizes in the thirty-three oncologic studies ranged from 32 to 1296 subjects, for a total in excess of 5000 patients.…”

“…Sample sizes in the thirty-three oncologic studies ranged from 32 to 1296 subjects, for a total in excess of 5000 patients. However, eleven of the thirty-three studies reported some data for the same patients: Sunnybrook Cancer Centre in Canada [25][26][27][28] , Bispebjerg Hospital in Denmark [38][39] , Linkoping Hospital in Sweden 15,35,36 , and Yale University 18,34 . For the patients described in the thirty-three papers, median age ranged from 53 to 74 years, and men were in a slight majority overall.…”

Clinical characteristics of asymptomatic left ventricular diastolic dysfunction and its association with self‐rated health and N‐terminal B‐type natriuretic peptide: a cross‐sectional study

“…In addition, a worsening of SRH among 625 participants with HF predicted the onset of the disease 25. In another study, breathlessness or shortness of breath was shown to be associated with poorer SRH 26. As breathlessness is a major symptom of HF, these findings suggest the importance of examining SRH together with other predictors.…”