Symptom Variability During Repeated Measurement Among Hospice Patients With Advanced Cancer

Abstract

(1) Symptom studies in advanced disease while difficult to conduct yield valuable information, (2) symptom relationships changed daily; strict timing of data collection is crucial for data analysis, (3) symptom monitoring following admission is an overlooked measure of risk assessment, (4) symptom prevalence studies alone for treatment follow-up may be misleading, (5) depression is an important predictor of symptoms and need to be more aggressively assessed and treated, (6) demographic characteristics may help identify symptom patterns and better direct treatment, (7) VRS rather than VAS was more reliable for assessing symptoms in hospice cancer patients.

A Randomized Trial of Weekly Symptom Telemonitoring in Advanced Lung Cancer

“…However, evaluation of the endpoint using a different, weekly symptom measure also found no differences. Some have suggested that patients with advanced lung cancer experience symptom variability warranting daily assessment (88), but we have no data to support this as an explanation for our findings. It may be unrealistic to achieve reduction in symptom burden in advanced lung cancer, where some disease or treatment symptoms are controlled as others emerge with disease progression (89).…”

Cancer symptom scale preferences: does one size fit all?

“…Participants also had the most difficulty completing it across all three symptoms. Lower VAS compliance rates support the suggestion that they are unsuitable for elderly inpatients with limited cognitive and abstract abilities 6 19 23. VAS may be inaccurate due to comprehension difficulty and the older age group represents the typical patient with cancer.…”

“…In contrast, CRS descriptors were considered by others to better reflect symptom experience variability. CRS may be more appropriate for those with a low education level and weaker ability for abstract thought13 or in serious illness 6 14. There was no statistically significant difference in the overall preferences between CRS and NRS.…”

“…A median of 10 (range 2–30) symptoms were reported when a systematic assessment was conducted,2–4 10-fold more than self-report 3. Assessment seems best done systematically3 6 7 to obtain the detail essential for effective symptom management 3. No single measure meets all the criteria for an ideal assessment 2…”

“…CRS provides word choices like ‘none’, ‘mild’, ‘moderate’ and ‘severe’. They may be more appropriate for older adults and children14 and in advanced disease 6 15. CRS is insensitive due to the limited response options which often underestimate change 16.…”