Cancer relating symptoms in homecare cancer patients: which impact in daily clinical practice?

Excerpt

Cancer treatment is increasingly being provided in outpatient settings [1], and quality of life (QoL) has become an increasingly popular outcome measure in healthcare during the past 20 years [2]. In fact most resources for cancer care focus on curative attempts while often ignoring the symptoms created by the disease and its treatment. Nowadays, it is increasingly common that the patients in the end of life phase choose to be cared for in their own home. Providing comfort and control of cancer-related symptoms can optimize the limited remaining time a patient has with his or her family and friends [3]. The aim of this report was to assess the clinical impact of the different cancer relating symptoms in homecare cancer patients. No results like the above have been published until now. A retrospective analysis of homecare patients with advanced cancer in palliative care, referred to our Local Unit Social Health (catchment area of approximately 150,000 inhabitants) and followed by our homecare service (ADI), was examined by 01/01/2012 to 31/12/2012. The symptom assessment was performed with a board called “symptom distress scale” (SDS), which was administered to patients weekly by the nursing staff; listed for each symptom, the patient was asked to indicate the appropriate number on a scale from 1 to 5, which indicated that he had experienced in the last week (for example, the number 1 indicated that he had not had that particular symptom, and number 5 indicated that he had had at most, and the numbers 2, 3, and 4 indicated amount intermediate between nothingness and the maximum). We considered in the all new patients cared for in the referring period, which were present in at least two subsequent evaluations. Follow-up time (TFU) was defined as the time homecare patients have been followed at ADI since initiating to the date of last clinical evaluation. A univariate analysis for survival, considering each cancer-related symptoms, was estimated according to the Kaplan–Meier method with statistical significance (p < 0.05) of differences evaluated by log-rank test, censoring surviving patients at the time of last follow-up. We have evaluated 28 patients. At the time of last follow-up (January 2013), 13 patients (46.4 %) were alive and 15 patients (53.6 %) were deceased. Median TFU was 35 days (range 7–138). Median survival time was 42 days (range 7–171). Median age was 75 years (range 26–89). Seventeen (60.7 %) were male and 11 (39.3 %) female. First and last evaluation of the different cancer relating symptoms are summarized, respectively, in Tables 1 and 2. By the univariate analysis, only the intestinal activity (p = 0.003, median survival 44 days, 95 % CI 26–62) and cough (p = 0.034, median survival 78 days, 95 % CI 0–213) seemed to statistically influence survival. The other cancer-related symptoms did not seem to have a prognostic significance (pain frequency: p = 0.929; pain intensity: p = 0.472; nausea frequency: p = 0.576; nausea intensity: p = 0.064; appetite: p = 0.714; breath: p = 0.091; fatigue: not computed because survival estimates cannot be computed since all observations were censored; insomnia: p = 0.163; concentration: p = 0.105; appearance: p = 0.801; mood: not computed because survival estimates cannot be computed since all observations were censored). Our experience seems to underline the importance of carefully and regularly evaluated cancer-related symptoms. In particular, we can highlight how there are good results as regards the management of pain (with a decrease of the intensity of the latter), while other symptoms (such as the decreased appetite) seem to have a more difficult to control (we must not forget, however, the factor given by the underlying disease and its inevitable progressive evolution). We have also achieved major improvements including with regard to concentration, appearance, and mood: this may be related to specialized figures such as that of the psychologist. The other symptoms are substantially unchanged over time. By the univariate analysis, only the intestinal activity and the cough seemed to statistically influence survival; there is no doubt as instead of all cancer-related symptoms correlate with QoL. In conclusion, we can consider how useful the intervention of the palliative homecare team in all cancer patients, and we encourage a careful and regular evaluation of the cancer-related symptoms, in order to improve QoL. …