1511 Symptom burden among patients with newly diagnosed incurable cancer

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Background: The World Health Organization (WHO) said that palliative care and cancer pain control are the only realistic treatment option for the majority of cancer patients who present in an advanced incurable stage, especially in lower-income countries. Ideally, palliative care is integrated from the point of diagnosis of incurable cancer. This would allow earlier identification and better management of symptoms in this group of patients. This study explores the symptom burden among patients with recently diagnosed incurable cancer in a lower-income setting. Materials and Methods: The study included patients with incurable cancer who presented to an Egyptian cancer center. Thirty-eight patients were interviewed within four weeks of diagnosis. Initially patients were asked to report voluntarily the symptoms they are experiencing and to name the most distressing one. This was followed by the systematic assessment of 57 symptoms. Symptoms were rated using a 4 point verbal rating scale (none, mild, moderate and severe). Results: The median age of patients was 51 years and 58% were males. The most common primary cancer site was the lung (21%) followed by the gastrointestinal system (18%). In addition to the 57 systematically assessed symptoms, patients voluntarily reported another 6 symptoms. The total number of symptom entries was 589, of which 74 (12.6%) were voluntary reported and 515 (87.4%) were found on systematic assessment. The average number of symptoms per patient was 16 and the median was 14 (range: 1−43). The average number of severe symptoms per patient was 3. The severity of symptoms was mild in 274 (46.5%) symptom entries, moderate in 200 (34%) and severe in 115 (19.5%). The total number of symptom entries related to the assessed 57 symptoms was 582. Patients voluntarily reported 2% of mild symptoms, 17% of moderate and 32% of severe. The ten most common symptoms were pain (71%), anxiety (58%), appetite loss (58%), fatigue (55%), weight loss (55%), insomnia (53%), weakness (50%), depressed mood (47%), shortness of breath (47%) and dry mouth (45%). The most distressing symptom was pain in 37% of patients, respiratory symptoms in 11% and weakness in 8%. Conclusions: In a lower-income setting, patients with recently diagnosed incurable cancer experience high symptom burden, especially pain. This supports the WHO advice to integrate palliative care and cancer pain control as early as possible in the course of disease of these patients. The majority of symptoms experienced by patients with incurable cancer are not voluntary reported, especially mild symptoms. Systematic assessment of symptoms is necessary to identify them early and to initiate management appropriately. No conflict of interest.