Prognostic significance of symptoms of advanced cancer patients

Abstract

8150 Background: Advanced cancer Palliative care patients have a variety of distressing symptoms. Their prognostic significance with regard to survival has not been systematically studied. Methods: Symptoms (type and severity) were assessed during an in-depth interview by a clinical nurse specialist with 166 cancer patients (46% male, 54% female) referred to a university hospital palliative care teamnurse specialist. WHO performance status: 2% 1, 27% 2, 50% 3, 21% 4. Diagnosis: 14% breast, 11% gynaecological, 19% gastrointestinal, 11% head and neck, 11% lung, 8% prostate and 26% other types of cancer. For 90 patients scores were available from the Edmonton Symptom Assessment Schedule (ESAS). Medical data and survival were recorded. The prognostic significance of the most frequent symptoms was analysed using Kaplan-Meier and multivariate linear and logistic regression analyses. Results: We recorded 29 different physical and psychological symptoms occurring in ≥10% of patients. 96% of the patients has have died. Survival at two months was 51%. In univariate analysis, headache, abdominal pain, pain in an extremity, anorexia, nausea, vomiting, dysphagia, dyspnea, drowsiness, confusion and depression were predictive of survival. The ESAS-scores for anorexia, nausea, dysphagia, dyspnea and drowsiness were significantly correlated with survival. After correcting for diagnosis, dyspnea, dysphagia, vomiting, confusion and nausea vomiting, confusion and nausea (occurring in 31%, 11%, 25%, 17% and 39%, 25%, 17% and 39% of patients, respectively) were independent predictive factors of survival. Patients with confusion, dyspnea, dysphagia or vomiting had an increased chance of dying within two months of 9.4, 7.3, 4.3, and 4.,3, respectively, compared to patients without these symptoms. Conclusion: Patients with confusion, dyspnea, dysphagia, vomiting or nausea have a significantly worse prognosis, regardless of diagnosis. A comprehensive assessment of symptoms is useful to determine prognosis in advanced cancer patients. No significant financial relationships to disclose.