Physical and psychological well-being in patients with stage IV GI cancer

Abstract

8266 Background: In many cancer centres, referral to palliative care often does not occur until near the end of life, despite substantial disease burden much earlier in the course of the illness. The present longitudinal study is being conducted to evaluate disease burden and its relation to psychological well being in patients with stage IV cancer receiving treatment at a comprehensive cancer center. Methods: Patients with stage IV gastrointestinal (GI) cancer are being recruited to this study from outpatient clinics at Princess Margaret Hospital, Toronto, Canada. Subjects who pass a cognitive screen (Short Orientation-Memory-Concentration Test ≥ 20) are administered self-report measures at 1–2 monthly intervals. These include: The Brief Pain Inventory, The Memorial Symptom Assessment Scale, The Beck Depression Inventory–II, The Beck Hopelessness Scale, The Schedule of Attitudes Towards Hastened Death, The Functional Assessment of Chronic Illness Therapy-Sp-12, and The Rosenberg Self-Esteem Scale. Results: Amongst 115 subjects with stage IV GI cancer recruited thus far (72% participation rate), multiple physical symptoms were common (\(\underline{\mathrm{M}}\)=5.0 ±3.7), including moderate to severe fatigue (52.2%), sleep disturbance (47.8%) and pain (46.1%). Psychological disturbances were also common, including moderate to severe depressive symptoms (20.9%), and hopelessness (26.1%). Pain, the number of physical symptoms, gender, self-reported spirituality and self-esteem together accounted for 53% of the variance in predicting depression (p<.01). Conclusions: Multiple physical symptoms, including significant pain, are common in patients with stage IV GI cancer, and these symptoms are associated with an increased risk of depression. Trials of early multidimensional palliative interventions are needed to determine to what extent these disturbances can be alleviated and quality of life can be improved in patients with stage IV disease. No significant financial relationships to disclose.