Cancer Patients Near End of Life Still Suffer Significant Symptom Burden

Patients with common cancers near end of life still require treatment for their symptoms in order to improve their quality of life, according to a study, which found that the physical symptom burden may be more significant than the psychological one.

“Patients dying with cancer can experience various physical and psychological symptoms. We aimed to determine the type and severity of symptoms within the last 6 months of life in a large real-world cohort of patients with cancer,” the researchers posited.

The study incorporated 2016–2017 data on patients with lung, colorectal, breast, prostate, or pancreatic cancer, who completed the revised Edmonton Symptom Assessment System (ESASr) questionnaire, which yielded physical and psychological symptom subscores as well as total symptom score. Symptoms were defined as none to mild (0–3) or moderate to severe (4–10). The correlation between clinical characteristics and symptom scores was analyzed.

A total of 1,159 patients were included in the study. The median age was 68 years, and 52.2% of patients were male. When classified by cancer type, there were 613 lung, 192 colorectal, 149 breast, 111 prostate, and 94 pancreatic cancer patients.

Patients were more likely to report moderate to severe physical symptom subscores and total symptom scores than moderate to severe psychological subscores, the researchers discovered. Further analyses found that women had a higher odds ratio (OR) of moderate to severe physical (1.52; 95% confidence interval [CI], 1.08-2.12; P=0.016), psychological (1.60; 95% CI, 1.14-2.26; P=0.006), and total symptom scores (1.80; 95% CI, 1.28-2.51; P=0.001). Lung cancer patients were at increased odds of moderate to severe physical (OR=1.95; 95% CI, 1.28-2.96; P=0.002) and psychological subscores (OR=1.78; 95% CI, 1.13-2.81; P=0.013), as well as moderate to severe total symptom scores (OR=1.83; 95% CI, 1.20-2.81; P=0.005). A correlation was observed between being closer to death and moderate to severe physical symptom subscores (OR=2.07; 95% CI, 1.33-3.23; P=0.001) and total symptom scores (OR=2.29; 95% CI, 1.46-3.60; P<0.001), but the relationship was not observed for psychological symptom scores (OR=1.34; 95% CI, 0.84-2.14; P=0.210), suggesting that the physical symptom burden was more significant.

The study was published in Supportive Cancer Care.

In their conclusion the researchers stated, “Symptom-directed care is still needed to improve the quality of end-of-life.”