Targets to improve palliative patients’ wellbeing identified

Pain, depression, drowsiness, fatigue, and appetite loss are the symptoms that most affect the wellbeing of cancer patients being treated palliatively, report Canadian researchers.

"By understanding the most important indices for wellbeing, these symptoms can be targeted individually and result in more effective and balanced symptom management strategies," writes the team in Clinical Oncology.

The findings highlight that emotional, as well as physical symptoms, are significant for the wellbeing of palliative care patients, and should be of "utmost concern" for teams involved in their care, suggest Edward Chow and colleagues from the University of Toronto in Ontario.

Participants of the study included 1439 patients from the Rapid Response Radiotherapy Program (1999-2009) who completed the Edmonton Symptom Assessment System (ESAS), which measures the level of distress induced by common cancer symptoms such as pain, anxiety, and drowsiness.

Overall, fatigue, wellbeing, and pain were rated most distressing by patients on the ESAS, with mean scores of 4.9, 4.5, and 4.3 (where a score of 10 equals maximum distress), report Chow et al.

Indeed, fatigue and appetite loss had stronger positive correlations with wellbeing than any other ESAS item.

The team found several factors that were significantly predictive of wellbeing, including worse distress in terms of the ESAS items fatigue and pain (odds ratios [ORs]=1.35 and 1.59, respectively), depression (OR=1.43), anxiety (1.21), and appetite (OR=2.12).

The only ESAS symptom not predictive of worse wellbeing was nausea, reports the team, "suggesting that this symptom is relatively better controlled." And the large affect of appetite on wellbeing has "not been shown previously in the literature," the team remarks.

A low Karnofsky Performance Score (indicating impaired functionality) was also significantly predictive of poor wellbeing.

Chow and co-workers highlight the importance of vigilant monitoring of emotional and psychological symptoms, which are "vastly underreported" and "have been shown to aggravate physical symptoms," they say.

Future work should confirm the predictability of these factors in the longitudinal setting and compare them with advanced cancer patients not represented in the current sample, they conclude.

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