Symptom prevalence, characteristics and distress in a cancer population

Abstract

Despite the importance of symptom control in the cancer population, few studies have systematically assessed the prevalence and characteristics of symptoms or the interactions between various symptom characteristics and other factors related to quality of life (QOL). As part of a validation study of a new symptom assessment instrument, inpatients and out-patients with prostate, colon, breast or ovarian cancer were evaluated using the Memorial Symptom Assessment Scale and other measures of psychological condition, performance status, symptom distress and overall quality of life. The mean age of the 243 avaluable patients was 55.5 years (range 23–86 years); over 60% were women and almost two-thirds had metastatic disease. The Karnofsky Performance Status (KPS) score was≤80 in 49.8% and 123 were inpatients at the time of assessment. Across tumour types, 40–80% experienced lack of energy, pain, feeling drowsy, dry mouth, insomnia, or symptoms indicative of psychological distress. Although symptom characteristics were variable, the proportion of patients who described a symptom as relatively intense or frequent always exceeded the proportion who reported it as highly distressing. The mean (±SD, range) number of symptoms per patient was 11.5±6.0 (0–25); inpatients had more symptoms than outpatients (13.5±5.4 vs. 9.7±6.0, p<0.002) and those with KPS≤80 had more symptoms than those with KPS>80 (14.8±5.5 vs. 9.2±4.9, p<0.0001). The number of symptoms was highly associated with heightened psychological distress and poorer quality of life (for example, r=0.67 for the relationship with the Functional Living Index-Cancer, a QOL measure). These data clarify the prevalence and characteristics of cancer-related symptoms and suggest that the number of symptoms per patient may be a useful quality of life indicator.