Symptom patterns of advanced cancer patients in a palliative care unit

Abstract

This study involved longitudinal evaluations of symptom severity and describes the symptom patterns of 77 terminal cancer patients (median age: 62 years; 61% female), selected from 537 consecutive patients admitted to the Palliative Care Unit of the National Taiwan University Hospital. The most common primary cancer sites in these patients were lung (23.4%), liver (15.6%), and stomach (13%). Nineteen physical and psychological symptoms were assessed using different scales. The median number of symptoms was 11 (range: 1-18) on admission, among which weakness, fatigue, anorexia, pain, and depression were the most common. A comparison of the initial symptom severity scores with those at one week after admission and two days before death suggested six symptom change patterns: A: continuous static (restless/heat, abdominal fullness, constipation, dizziness, and insomnia); B: static-increase (fatigue, weakness, nausea/vomiting, taste alteration, dysphagia, diarrhea, dry mouth, and night sweats); C: decrease-static (pain and depression); D: decrease-increase (anorexia and dyspnea); E: static-decrease (aggression); and F: gradually decrease (anxiety). These six symptom patterns can be divided into two categories on the basis of the relative severity of symptoms between one week after admission and two days before death. The first category included patterns A, C, E and F, and the symptoms improved with palliative care. However, the symptoms in the second category (patterns B and D), which were associated with the anorexia-cachexia syndrome and dyspnea, did not show improvement. As symptom management is an essential component of palliative care, holistic care, which encompasses physical, psychosocial and spiritual aspects, represents a rational approach for the relief of these incurable symptoms at the end stage of life for these patients.

Prevalence of oral mucositis, dry mouth, and dysphagia in advanced cancer patients

“…Data were even more relevant in another study in which 88 % of palliative care patients reported dry mouth, with an intensity similar to that found in this study [13]. Dry mouth was one of the symptoms that presented a tendency to persist or to worse after admission to a palliative care unit [17]. This is consistent with other data showing that the prevalence of dry mouth was 25 and 61 % at admission and during the patients' course, respectively.…”

An Advanced Practice Nurse Coordinated Multidisciplinary Intervention for Patients with Late-Stage Cancer: A Cluster Randomized Trial

“…Characteristics of late-stage cancer that require coordinated palliative care as a part of comprehensive cancer care include multiple physical needs, intense psychosocial distress, and complex patient and caregiver needs. 2 The American Society of Clinical Oncology has recommended that there be full integration of palliative care as a routine part of comprehensive cancer care in the United States by 2020. 3 We know that the integration of early palliative care by a palliative care team enhances patients' quality of life (QOL), including survival.…”

Exercise and Nutrition Interventions in Advanced Lung Cancer: A Systematic Review

“…Pain, fatigue, anorexia, and weight loss are some of the most prevalent physical symptoms in advanced cancers 1,2 . Unintentional weight loss is recognized as an independent predictor of poor health and earlier death in advanced cancer 3,4 .…”