Symptoms and Problem Clusters in Cancer and Non-Cancer Patients in Specialized Palliative Care—Is There a Difference?

Stiel, Stephanie; Matthies, Dominik M.K.; Seuß, Dominik; Walsh, Declan; Lindena, G.; Ostgathe, Christoph

doi:10.1016/j.jpainsymman.2013.08.018

Cited by 42 publications

(37 citation statements)

References 32 publications

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“…[26] In our sample the prevalence of these issues resonates with Ann-Yi S study in terms of the percentage of patients cared for in the psychology service [8], although that study was conducted only with cancer patients. On the other hand, clusters of physical and non physical symptoms occur and are common in both cancer and non cancer patients [27,28]. Also, the prevalence of depression in the present study was somewhat higher than the one presented in the Antunes study on screening for depression using one item of the Palliative care Outcome Scale, namely 17.5% (C.I.…”

Section: Discussioncontrasting

confidence: 71%

Determining the prevalence of palliative needs and exploring screening accuracy of depression and anxiety items of the Integrated Palliative care Outcome Scale – a multi-centre study

Antunes

Rodrigues

Higginson

et al. 2020

Preprint

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Background: patients with palliative needs often experience high symptom burden which causes suffering to themselves and their families. Depression and psychological distress should not be considered a “normal event” in advanced disease patients and should be screened, diagnosed, acted on and followed-up. Psychological distress has been associated with greater physical symptom severity, suffering, and mortality in cancer patients. A holistic, but short measure should be used for physical and non-physical needs assessment. The Integrated Palliative care Outcome Scale is one such measure. This work aims to determine palliative needs of patients and explore screening accuracy of two items pertaining to psychological needs.Methods: multi-centred observational study using convenience sampling. Data were collected in 9 Portuguese centres. Inclusion criteria: ≥18 years, mentally fit to give consent, diagnosed with an incurable, potentially life-threatening illness. Exclusion criteria: patient in distress ("unable to converse for a period of time"), cognitively impaired. Descriptive statistics used for demographics. Receiving Operator Characteristics curves and Area Under the Curve for anxiety and depression discriminant properties against the Hospital Anxiety and Depression Scale. Results: 1703 individuals were screened between July 1st, 2015 and February 2016. A total of 135 (7.9%) were included. Main reason for exclusion was being healthy (75.2%). The primary care centre screened most individuals, as they have the highest rates of daily patients and the majority are healthy. Mean age is 66.8 years (SD 12.7), 58 (43%) are female. Most patients had a cancer diagnosis 109 (80.7%). Items scoring highest (=4) were: family or friends anxious or worried (36.3%); feeling anxious or worried about illness (13.3%); feeling depressed (9.6%). Using a cut-off score of 2/3, Area Under the Curve for depression and anxiety items were above 70%.Conclusions: main palliative needs were psychological, family related and spiritual. This suggests that clinical teams may better manage physical issues and there is room for improvement regarding non-physical needs. Using the Integrated Palliative care Outcome Scale systematically could aid clinical teams screening patients for distressing needs and track their progress in assisting patients and families with those issues.Trial Registration: Not applicable. This was not an intervention study.

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Section: Discussioncontrasting

confidence: 71%

Determining the prevalence of palliative needs and exploring screening accuracy of depression and anxiety items of the Integrated Palliative care Outcome Scale – a multi-centre study

Antunes

Rodrigues

Higginson

et al. 2020

Preprint

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“…The symptoms forming cluster with pain showed differences in this study. Previous studies have reported pain to cluster with lack of energy and constipation[111213] as well as presenting as a single group without clustering. [14] Pain detraction is considered to be most important symptom impact on quality of life.…”

Section: Discussionmentioning

confidence: 99%

Identification of symptom clusters in cancer patients at palliative care clinic

Özalp¹,

Uysal

Oğuz³

et al. 2017

Asia-Pacific Journal of Oncology Nursing

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Objective:Cancer patients often experience a large number of symptoms together. The aim of this study is to determine the symptom clusters in cancer patients at palliative care clinic.Methods:Hundred and seventy consecutive patients were enrolled in the study. Memorial Symptom Assessment Scale was used for symptom assessment of the patients.Results:The most experienced symptoms by the patients during the past week before hospitalization in palliative care clinic were lack of energy (95.4%), weight loss (91.2%), lack of appetite (89.4%), pain (88.2%), dry mouth (87.6%), feeling sad (87.6%), feeling nervous (82.9%), worrying (81.2%), and feeling irritable (80.6%). Five symptom clusters were defined. First cluster: pain, feeling nervous, dry mouth, worrying, feeling irritable, weight loss; second cluster: feeling drowsy, numbness/tingling in hands/feet, difficulty in sleeping, dizziness, constipation, I do not look like myself; third cluster: nausea, vomiting; fourth cluster: shortness of breath, difficulty in swallowing, cough, change in the way food tastes; and fifth cluster: feeling bloated, problems with urination, diarrhea, itching, mouth sores, hair loss, swelling of arm or legs, change in the skin.Conclusions:We encountered various symptom clusters in advanced cancer patients. Identification of symptom clusters and knowledge of cluster composition in oncological population may particularly contribute individualization of the treatment.

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“…A total of 19 symptoms were assessed. All patients assessed by the palliative care team were requested to complete the revised version of the Edmonton Symptom Assessment Scale (ESAS) and 10 other symptoms using a Likert scale (1)(2)(3)(4)(5), as a routine component of the initial and subsequent consultations. The ESAS is a standardized 0-10 numerical rating tool (0 = not a problem, 10 = worst imaginable level of symptom) that is commonly used by palliative care teams to evaluate the intensity of nine symptoms: pain, dyspnea, lack of appetite, nausea, fatigue, drowsiness, anxiety, depression, and general well-being [20,21].…”

Section: Study Measures and Data Collectionmentioning

confidence: 99%

Symptom clusters and survival in Portuguese patients with advanced cancer

et al. 2016

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This study aimed to identify clusters of symptoms, to determine the patient characteristics associated with identified, and determine their strength of association with survival in patients with advanced cancer (ACPs). Consecutively eligible ACPs not receiving cancer‐specific treatment, and referred to a Tertiary Palliative Care Clinic, were enrolled in a prospective cohort study. At first consultation, patients rated 9 symptoms through the Edmonton Symptom Assessment System (0–10 scale) and 10 others using a Likert scale (1–5). Principal component analysis was used in an exploratory factor analysis to identify. Of 318 ACPs, 301 met eligibility criteria with a median (range) age of 69 (37–94) years. Three SCs were identified: neuro‐psycho‐metabolic (NPM) (tiredness, lack of appetite, lack of well−being, dyspnea, depression, and anxiety); gastrointestinal (nausea, vomiting, constipation, hiccups, and dry mouth) and sleep impairment (insomnia and sleep disturbance). Exploratory factor analysis accounted for 40% of variance of observed variables in all SCs. Shorter survival was observed for patients with the NPM cluster (58 vs. 23, P < 0.001), as well as for patients with two or more SCs (45 vs. 21, P = 0.005). In a multivariable model for survival at 30‐days, age (HR: 0.98; 95% CI: 0.97–0.99; P = 0.008), hospitalization at inclusion (HR: 2.27; 95% CI: 1.47–3.51; P < 0.001), poorer performance status (HR: 1.90, 95% CI: 1.24–2.89; P = 0.003), and NPM (HR: 1.64; 95% CI: 1.17–2.31; P = 0.005), were associated with worse survival. Three clinically meaningful SC in patients with advanced cancer were identifiable. The NPM cluster and the presence of two or more SCs, had prognostic value in relation to survival.

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Symptoms and Problem Clusters in Cancer and Non-Cancer Patients in Specialized Palliative Care—Is There a Difference?

Cited by 42 publications

References 32 publications

Determining the prevalence of palliative needs and exploring screening accuracy of depression and anxiety items of the Integrated Palliative care Outcome Scale – a multi-centre study

Determining the prevalence of palliative needs and exploring screening accuracy of depression and anxiety items of the Integrated Palliative care Outcome Scale – a multi-centre study

Identification of symptom clusters in cancer patients at palliative care clinic

Symptom clusters and survival in Portuguese patients with advanced cancer

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