Abstract
The delineation of populations of cancer patients with complex symptoms can inform the planning and delivery of supportive care services. We explored the physical, psychosocial, and practical concerns experienced by patients attending an ambulatory oncology symptom control clinic. Patients attending a Pain Clinic at a large tertiary cancer centre were invited to complete screening measures assessing distress, pain, fatigue, anxiety, depression, and practical and psychosocial problems. A matched sample of patients who did not attend the Pain Clinic were selected as a comparison group. Of all eligible Pain Clinic patients, 46 (77%) completed the measures; so did 46 comparison group patients. The percentages of patients reporting distress (78.3%), pain (93.5%), and fatigue (93.5%) were higher among Pain Clinic patients than among the comparison patients. A higher percentage of Pain Clinic patients also reported multiple, severe, concurrent symptoms: 87% scored 7 or higher in at least one of the pain, fatigue, or distress scales, and 30.4% of the patients scored 7 or higher on all three. The most common problem areas were feeling a burden to others, trouble talking with friends and family, spirituality, and sleep difficulties. Higher levels of multiple, concurrent symptoms and psychosocial problems were found in Pain Clinic patients than in a group of patients who did not attend the Pain Clinic. Routine screening and triaging of cancer patients using a comprehensive and standardized panel of questions can facilitate symptom assessment and management, and can inform program planning.
Highlights
Distress in cancer patients has been defined as “an unpleasant emotional experience that interferes with [the] ability to cope with a diagnosis of cancer or its treatments” 1
The most common problem areas were feeling a burden to others, trouble talking with friends and family, spirituality, and sleep difficulties
Cross-sectional studies have documented that approximately 35%–45% of cancer patients in North America experience significant levels of distress [2,3], and in the advanced cancer population, the prevalence of distress may be as high as 60% 4,5
Summary
Distress in cancer patients has been defined as “an unpleasant emotional experience that interferes with [the] ability to cope with a diagnosis of cancer or its treatments” 1. Cross-sectional studies have documented that approximately 35%–45% of cancer patients in North America experience significant levels of distress [2,3], and in the advanced cancer population, the prevalence of distress may be as high as 60% 4,5. Initial conceptualizations of distress focused on anxiety and depression, recent models view distress more broadly as resulting from any, or a combination of, psychosocial, practical, and physical concerns 6. Physical symptoms have been extensively examined [7,8,9,10], and research indicates that more severe symptoms are more distressing for patients 11. Most studies that include a broader construct of distress have focused to a greater extent on psychological and symptom distress in the advanced e53 Current Oncology—Volume 19, Number 2, April 2012 cancer population to the exclusion of practical and other psychosocial concerns. Some studies have been more inclusive in their definition of distress, using the Problem Checklist tool 1 in the assessment of lung cancer patients 12, bone marrow transplant patients 13, and heterogeneous cohorts of cancer patients [14,15]; those studies did not examine patients with advanced or progressive disease
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