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Erschienen in: Supportive Care in Cancer 7/2013

01.07.2013 | Original Article

Symptom burden in palliative care patients: perspectives of patients, their family caregivers, and their attending physicians

verfasst von: Karin Oechsle, Kathrin Goerth, Carsten Bokemeyer, Anja Mehnert

Erschienen in: Supportive Care in Cancer | Ausgabe 7/2013

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Abstract

Rationale

The purpose of this study was to prospectively evaluate the perspectives of palliative care patients, their family caregivers, and their attending palliative care specialists on frequency, intensity, distress, and treatment requirement of the patient’s physical and psychological symptoms.

Patients and methods

Forty advanced cancer patients and their family caregivers were recruited through a palliative care inpatient ward within 24 h after admission. Patients, caregivers, and physicians completed a modified version of the Memorial Symptom Assessment Scale (including perceived treatment requirement).

Results

Thirty-nine patients (98 %) suffered from at least one symptom frequently or almost constantly (median number 5; range, 0–9). Most frequent symptoms were lack of energy (95 %), tiredness (88 %), and pain (80 %), which were scored correspondingly by patients, caregivers, and physicians to be the most intensive, distressing, and treatment requiring. Treatment requirement was determined by symptom intensity or distress in patients and physicians, but by distress in caregivers. Significant differences in symptom burden between patients, caregivers, and physicians were found with regard to pain (p = .007), tiredness (p = .037), lack of energy (p < .05), anxiety (p < .05), and sadness (p < .05). Physicians underestimated 60 % of symptom dimensions, while the caregivers overestimated 77 %; however, overall median scoring differences were limited with −.10 (range, −.55 to +.25) between patients and physicians and +.33 (range, −.78 to +.61) between patients and family caregivers.

Conclusions

While physicians tended to underestimate, family caregivers tended to overestimate the patient’s symptoms. Therefore, adequate symptom treatment can only be successful in a close dialog between patients, their caregivers, and a multidisciplinary team.
Literatur
1.
Zurück zum Zitat Grond S, Zech D, Diefenbach C et al (1994) Prevalence and pattern of symptoms in patients with cancer pain: a prospective evaluation of 1635 cancer patients referred to a pain clinic. J Pain Symptom Manage 9:372–382PubMedCrossRef Grond S, Zech D, Diefenbach C et al (1994) Prevalence and pattern of symptoms in patients with cancer pain: a prospective evaluation of 1635 cancer patients referred to a pain clinic. J Pain Symptom Manage 9:372–382PubMedCrossRef
3.
Zurück zum Zitat Harding R, Selman L, Agupio G et al (2011) The prevalence and burden of symptoms amongst cancer patients attending palliative care in two African countries. Eur J Cancer 47:51–56PubMedCrossRef Harding R, Selman L, Agupio G et al (2011) The prevalence and burden of symptoms amongst cancer patients attending palliative care in two African countries. Eur J Cancer 47:51–56PubMedCrossRef
4.
Zurück zum Zitat Manitta V, Zordan R, Cole-Sinclair M et al (2011) The symptom burden of patients with hematological malignancy: a cross-sectional observational study. J Pain Symptom Manage 42:432–442PubMedCrossRef Manitta V, Zordan R, Cole-Sinclair M et al (2011) The symptom burden of patients with hematological malignancy: a cross-sectional observational study. J Pain Symptom Manage 42:432–442PubMedCrossRef
5.
Zurück zum Zitat Chang VT, Hwang SS, Feuerman M et al (2000) Symptom and quality of life survey of medical oncology patients at a veterans affairs medical center: a role for symptom assessment. Cancer 88:1175–1183PubMedCrossRef Chang VT, Hwang SS, Feuerman M et al (2000) Symptom and quality of life survey of medical oncology patients at a veterans affairs medical center: a role for symptom assessment. Cancer 88:1175–1183PubMedCrossRef
6.
Zurück zum Zitat Barbera L, Seow H, Howell D et al (2010) Symptom burden and performance status in a population-based cohort of ambulatory cancer patients. Cancer 116:5767–5776PubMedCrossRef Barbera L, Seow H, Howell D et al (2010) Symptom burden and performance status in a population-based cohort of ambulatory cancer patients. Cancer 116:5767–5776PubMedCrossRef
7.
Zurück zum Zitat Kirkova J, Rybicki L, Walsh D et al (2011) The relationship between symptom prevalence and severity and cancer primary site in 796 patients with advanced cancer. Am J Hosp Palliat Care 28:350–355PubMedCrossRef Kirkova J, Rybicki L, Walsh D et al (2011) The relationship between symptom prevalence and severity and cancer primary site in 796 patients with advanced cancer. Am J Hosp Palliat Care 28:350–355PubMedCrossRef
8.
Zurück zum Zitat Kirkova J, Walsh D, Rybicki L et al (2010) Symptom severity and distress in advanced cancer. Palliat Med 24:330–339PubMedCrossRef Kirkova J, Walsh D, Rybicki L et al (2010) Symptom severity and distress in advanced cancer. Palliat Med 24:330–339PubMedCrossRef
9.
Zurück zum Zitat Lobchuk MM, Degner LF (2002) Symptom experiences: perceptual accuracy between advanced-stage cancer patients and family caregivers in the home care setting. J Clin Oncol 20:3495–3507PubMedCrossRef Lobchuk MM, Degner LF (2002) Symptom experiences: perceptual accuracy between advanced-stage cancer patients and family caregivers in the home care setting. J Clin Oncol 20:3495–3507PubMedCrossRef
10.
Zurück zum Zitat Silveira MJ, Given CW, Given B et al (2010) Patient-caregiver concordance in symptom assessment and improvement in outcomes for patients undergoing cancer chemotherapy. Chronic Illn 6:46–56PubMedCrossRef Silveira MJ, Given CW, Given B et al (2010) Patient-caregiver concordance in symptom assessment and improvement in outcomes for patients undergoing cancer chemotherapy. Chronic Illn 6:46–56PubMedCrossRef
11.
Zurück zum Zitat Sneeuw KC, Aaronson NK, Sprangers MA et al (1997) Value of caregiver ratings in evaluating the quality of life of patients with cancer. J Clin Oncol 15:1206–1217PubMed Sneeuw KC, Aaronson NK, Sprangers MA et al (1997) Value of caregiver ratings in evaluating the quality of life of patients with cancer. J Clin Oncol 15:1206–1217PubMed
12.
Zurück zum Zitat Yeşilbalkan OU, Okgün A (2010) Patients’ self reports and caregivers’ perception of symptoms in Turkish cancer patients. Eur J Oncol Nurs 14:119–124PubMedCrossRef Yeşilbalkan OU, Okgün A (2010) Patients’ self reports and caregivers’ perception of symptoms in Turkish cancer patients. Eur J Oncol Nurs 14:119–124PubMedCrossRef
13.
Zurück zum Zitat Robinson JA, Crawford GB (2010) Do palliative patients and carers agree about patients’ psychological functioning? Palliat Support Care 8:69–74PubMedCrossRef Robinson JA, Crawford GB (2010) Do palliative patients and carers agree about patients’ psychological functioning? Palliat Support Care 8:69–74PubMedCrossRef
14.
Zurück zum Zitat Oechsle K, Goerth K, Bokemeyer C et al. (2012) Anxiety and depression in care givers of patients with advanced cancer: impact on their perspective of the patient’s symptom burden. (in press) Oechsle K, Goerth K, Bokemeyer C et al. (2012) Anxiety and depression in care givers of patients with advanced cancer: impact on their perspective of the patient’s symptom burden. (in press)
15.
Zurück zum Zitat Portenoy RK, Thaler HT, Kornblith AB et al (1994) The Memorial Symptom Assessment Scale: an instrument for the evaluation of symptom prevalence, characteristics and distress. Eur J Cancer 30:1326–1336CrossRef Portenoy RK, Thaler HT, Kornblith AB et al (1994) The Memorial Symptom Assessment Scale: an instrument for the evaluation of symptom prevalence, characteristics and distress. Eur J Cancer 30:1326–1336CrossRef
16.
Zurück zum Zitat Santiago A, Portela MA, Ramos L et al (2012) A new palliative care consultation team at the oncology department of a university hospital: an assessment of initial efficiency and effectiveness. Support Care Cancer 20:2199–203. doi:10.1007/s00520-012-1476-x PubMedCrossRef Santiago A, Portela MA, Ramos L et al (2012) A new palliative care consultation team at the oncology department of a university hospital: an assessment of initial efficiency and effectiveness. Support Care Cancer 20:2199–203. doi:10.​1007/​s00520-012-1476-x PubMedCrossRef
17.
Zurück zum Zitat Kirkova J, Rybicki L, Walsh D et al (2012) Symptom prevalence in advanced cancer: age, gender, and performance status interactions. Am J Hosp Palliat Care 29:139–145PubMedCrossRef Kirkova J, Rybicki L, Walsh D et al (2012) Symptom prevalence in advanced cancer: age, gender, and performance status interactions. Am J Hosp Palliat Care 29:139–145PubMedCrossRef
20.
Zurück zum Zitat Cavers D, Hacking B, Erridge SE et al (2012) Social, psychological and existential well-being in patients with glioma and their caregivers: a qualitative study. CMAJ 184:E373–82PubMed Cavers D, Hacking B, Erridge SE et al (2012) Social, psychological and existential well-being in patients with glioma and their caregivers: a qualitative study. CMAJ 184:E373–82PubMed
21.
Zurück zum Zitat Williams A, McCorkle R (2011) Cancer family caregivers during the palliative, hospice, and bereavement phases: a review of the descriptive psychosocial literature. Palliat Support Care 9:315–325PubMedCrossRef Williams A, McCorkle R (2011) Cancer family caregivers during the palliative, hospice, and bereavement phases: a review of the descriptive psychosocial literature. Palliat Support Care 9:315–325PubMedCrossRef
22.
Zurück zum Zitat Rosenberger C, Hocker A, Cartus M et al (2012) Outpatient psycho-oncological care for family members and patients: access, psychological distress and supportive care needs. Psychother Psychosom Med Psychol 62:185–194PubMedCrossRef Rosenberger C, Hocker A, Cartus M et al (2012) Outpatient psycho-oncological care for family members and patients: access, psychological distress and supportive care needs. Psychother Psychosom Med Psychol 62:185–194PubMedCrossRef
23.
Zurück zum Zitat Sneeuw KC, Aaronson NK, Sprangers MA et al (1999) Evaluating the quality of life of cancer patients: assessments by patients, significant others, physicians and nurses. Br J Cancer 81:87–94PubMedCrossRef Sneeuw KC, Aaronson NK, Sprangers MA et al (1999) Evaluating the quality of life of cancer patients: assessments by patients, significant others, physicians and nurses. Br J Cancer 81:87–94PubMedCrossRef
25.
Zurück zum Zitat Rhondali W, Hui D, Kim SH et al (2012) Association between patient-reported symptoms and nurses’ clinical impressions in cancer patients admitted to an acute palliative care unit. J Palliat Med 15:301–307PubMed Rhondali W, Hui D, Kim SH et al (2012) Association between patient-reported symptoms and nurses’ clinical impressions in cancer patients admitted to an acute palliative care unit. J Palliat Med 15:301–307PubMed
26.
Zurück zum Zitat Zimmermann C, Burman D, Bandukwala S et al (2010) Nurse and physician inter-rater agreement of three performance status measures in palliative care outpatients. Support Care Cancer 18:609–616PubMedCrossRef Zimmermann C, Burman D, Bandukwala S et al (2010) Nurse and physician inter-rater agreement of three performance status measures in palliative care outpatients. Support Care Cancer 18:609–616PubMedCrossRef
27.
Zurück zum Zitat Jones JM, McPherson CJ, Zimmermann C et al (2011) Assessing agreement between terminally ill cancer patients’ reports of their quality of life and family caregiver and palliative care physician proxy ratings. J Pain Symptom Manage 42:354–365PubMedCrossRef Jones JM, McPherson CJ, Zimmermann C et al (2011) Assessing agreement between terminally ill cancer patients’ reports of their quality of life and family caregiver and palliative care physician proxy ratings. J Pain Symptom Manage 42:354–365PubMedCrossRef
28.
Zurück zum Zitat Kirkova J, Walsh D, Russel M et al (2010) Symptom assessment in palliative medicine: complexities and challenges. Am J Hosp Palliat Care 27:75–83PubMedCrossRef Kirkova J, Walsh D, Russel M et al (2010) Symptom assessment in palliative medicine: complexities and challenges. Am J Hosp Palliat Care 27:75–83PubMedCrossRef
Metadaten
Titel
Symptom burden in palliative care patients: perspectives of patients, their family caregivers, and their attending physicians
verfasst von
Karin Oechsle
Kathrin Goerth
Carsten Bokemeyer
Anja Mehnert
Publikationsdatum
01.07.2013
Verlag
Springer-Verlag
Erschienen in
Supportive Care in Cancer / Ausgabe 7/2013
Print ISSN: 0941-4355
Elektronische ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-013-1747-1

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