The Relation between the Severity of Pain and Common Symptoms in Patients with Metastatic Cancer

Abstract

Background: There is a relation between the severity of pain and common symptoms in patients with metastatic cancer. Aim: This study was done to explore this relation among Egyptian patients with advanced cancer. Methods: The study included 120 adult metastatic cancer patients with pain from two cancer centers in Cairo and Sharkia, Egypt. Pain and other common symptoms were assessed using the Arabic version of the Edmonton Symptom Assessment System (ESAS). The Eastern Cooperative Oncology Group (ECOG) performance scale was used to assess performance status. Results:The prevalence of ESAS symptoms was high among patients with cancer pain (tiredness, 94%; drowsiness, 63%; nausea, 60%; lack of appetite, 77%; shortness of breath, 53%; depression, 88%; anxiety, 83%; poor wellbeing, 96%). The ECOG performance scale was 1 in 21 (17.5%) patients, 2 in 57 (47.5%), 3 in 38 (31.7%) and 4 in 4 (3.3%). The average ESAS score was 33.9 ± 13.8, 48.9 ± 14.7, 58 ± 15.4 and 70 ± 5.5 among patients with ECOG score 1, 2, 3 and 4; respectively (p < 0.001). There was no significant difference in the average score of any of the ESAS items according to the site of metastases. There was a significant positive correlation between the pain score and the scores of tiredness (p<0.001), nausea (p=0.037), lack of appetite (p<0.001), shortness of breath (p=0.001), depression (p<0.001), anxiety (p<0.001) and poor wellbeing (p<0.001). Conclusion: Egyptian patients with cancer pain experience high symptom burden. The severity of pain strongly correlates with the presence and severity of other ESAS symptoms. Systematic assessment of other symptoms is indispensable in patients with cancer pain for proper control of symptoms and improving quality of life.

The Relationship between Distressing Symptoms and Performance Status among Cancer Patients Receiving Palliative Care

“…Congruent with our results, other researchers found a significant negative relationship between symptom burden and functional status of advanced cancer patients [27][28][29][30][31] . In a recent study from Egypt that included patients with metastatic cancer, the total average ESAS score differed significantly according to the Eastern Cooperative Oncology Group (ECOG) performance scale from 34 in patients with an ECOG score of 1 to 70 in patients with an ECOG score…”

“…In this context, little is known about the needs of Egyptian terminal cancer patients 15,26,27 . The current study is one of the few studies that addressed the needs of PC patients in Egypt.…”

“…Severity Mean score ± SD 27 . Similarly, in a study from Japan that included 292 cancer patients, the total ESAS-r score was significantly higher among patients with an ECOG score of 2-4 than those with a score of 0-1 (p<0.0001) 28 .…”

Factors associated with palliative care symptoms in cancer patients in Palestine

“…However, another study reported that pain was the most common symptom in the diagnosis stage of incurable cancers 22 . Furthermore, most of the patients included in the study were tired (94%), anxious (87.5%), and depressed (83%) 23 . Using the ESAS scale as a guide to identify and understand the main problems can help establish appropriate care for cancer patients 24 .…”