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Published in: Supportive Care in Cancer 3/2009

01-03-2009 | Original Article

Descriptive analysis of clinical factors affecting terminally ill cancer patients

Authors: A. M. Jiménez-Gordo, J. Feliu, B. Martínez, J. de-Castro, N. Rodríguez-Salas, N. Sastre, Y. Vilches, E. Espinosa, J. R. Rodríguez-Aizcorbe, M. González-Barón

Published in: Supportive Care in Cancer | Issue 3/2009

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Abstract

Goals of work

To make a descriptive analysis of clinical and laboratories parameters in advanced neoplastic patients.

Materials and methods

We interviewed 406 terminally ill cancer patients to study demographic and neoplastic data, 24 graded symptoms, 21 analytical parameters and scales to evaluate general condition, quality of life and independence in daily activities.

Main results

An average of 9.3 symptoms per patient were detected and median survival was 26.5 days. Most frequent symptoms were asthenia (96.8%), anorexia (94.8%), weight loss (88.1%) and pain (80.5%). Principal laboratory abnormalities were high blood sedimentation rate (96%), high cytolysis and cholestasis enzyme levels (50–77%), anemia (81.5%), low protein (66%) and low albumin levels (67%). Symptom prevalence was different according to age, gender, primary tumour, location of metastasis, laboratory parameters, performance status, quality of life or independence in daily-living activities.

Conclusions

We should know more frequent symptoms affecting terminal cancer patients and any factor contributing to it to provide more comfort in the final phases of life.
Literature
1.
go back to reference Addington-Hall JM, MacDonald LD, Anderson HR (1990) Can the Spitzer quality of life index help to reduce prognostic uncertainty in terminal care? Br J Cancer 62(4):695–699PubMed Addington-Hall JM, MacDonald LD, Anderson HR (1990) Can the Spitzer quality of life index help to reduce prognostic uncertainty in terminal care? Br J Cancer 62(4):695–699PubMed
2.
go back to reference Ahmedazai SH, Walsh D (2000) Palliative medicine and modern cancer care. Semin Oncol 27(1):1–6 Ahmedazai SH, Walsh D (2000) Palliative medicine and modern cancer care. Semin Oncol 27(1):1–6
3.
go back to reference Allard P, Dionne A (1995) Factors associated with length of survival among 1,081 terminally ill cancer patients. J Palliat Care 11(3):20–24PubMed Allard P, Dionne A (1995) Factors associated with length of survival among 1,081 terminally ill cancer patients. J Palliat Care 11(3):20–24PubMed
4.
go back to reference Belloc Calmet J, Porta Serra M, Malats Riera N, Gallen Castillo M, Planas Domingo J (1994) El síntoma inicial atribuible al cáncer en los tumores del tubo digestivo. Un análisis de la concordancia entre el paciente y el médico. Med. Clin 103:401–407 Belloc Calmet J, Porta Serra M, Malats Riera N, Gallen Castillo M, Planas Domingo J (1994) El síntoma inicial atribuible al cáncer en los tumores del tubo digestivo. Un análisis de la concordancia entre el paciente y el médico. Med. Clin 103:401–407
5.
go back to reference Brescia FJ, Adler D, Gray G, Ryan MA, Cimino J, Mamtani R (1990) Hospitalized advanced cancer patients: a profile. J. Pain Symptom Manage 5:221–227PubMedCrossRef Brescia FJ, Adler D, Gray G, Ryan MA, Cimino J, Mamtani R (1990) Hospitalized advanced cancer patients: a profile. J. Pain Symptom Manage 5:221–227PubMedCrossRef
6.
go back to reference Bruera E (1990) Symptom control in patients with cancer. J Psychosoc Oncol 8:47–73CrossRef Bruera E (1990) Symptom control in patients with cancer. J Psychosoc Oncol 8:47–73CrossRef
7.
go back to reference Burkberg J, Penman D, Holland J (1984) Depression in hospitalized cancer patients. Psychosom Med 46:199–212 Burkberg J, Penman D, Holland J (1984) Depression in hospitalized cancer patients. Psychosom Med 46:199–212
8.
go back to reference Chiu TY, Hu WY, Chen CY (2000) Prevalence and severity of symptoms in terminal cancer patients: a study in Taiwan. Support Care Cancer 8:311–313PubMedCrossRef Chiu TY, Hu WY, Chen CY (2000) Prevalence and severity of symptoms in terminal cancer patients: a study in Taiwan. Support Care Cancer 8:311–313PubMedCrossRef
10.
go back to reference Curtis EB (1991) Common symptoms in patients with advanced cancer. J Palliat Care 7(2):25–29PubMed Curtis EB (1991) Common symptoms in patients with advanced cancer. J Palliat Care 7(2):25–29PubMed
11.
go back to reference Davidson J, Turnbull C, Strickland R, Miller R, Graves K (1986) The Montgomery–Asberg depression scale: reliability and validity. Acta Psychiatr Scand 73:544–548PubMedCrossRef Davidson J, Turnbull C, Strickland R, Miller R, Graves K (1986) The Montgomery–Asberg depression scale: reliability and validity. Acta Psychiatr Scand 73:544–548PubMedCrossRef
12.
go back to reference Donnelly SM, Walsh TD, Rybicki L (1994) The symptoms of advanced cancer in 1000 patients. J Palliat Care 10(4):57 Donnelly SM, Walsh TD, Rybicki L (1994) The symptoms of advanced cancer in 1000 patients. J Palliat Care 10(4):57
13.
go back to reference Dowd S, Davidhizar R (1999) Opening up to the Katz Index. Elder Care 11(1):9–12PubMed Dowd S, Davidhizar R (1999) Opening up to the Katz Index. Elder Care 11(1):9–12PubMed
14.
go back to reference Dunphy KP, Amesbury BDW (1990) A comparison of hospice and home care patients: patterns of referral, patient characteristics and predictors of place of death. Palliat Med 4:105–111CrossRef Dunphy KP, Amesbury BDW (1990) A comparison of hospice and home care patients: patterns of referral, patient characteristics and predictors of place of death. Palliat Med 4:105–111CrossRef
15.
go back to reference Expósito MC, Bruera E (1996) Enfoque terapéutico de la deshidratación en pacientes con cáncer terminal. Med Paliat 3(2):59–66 Expósito MC, Bruera E (1996) Enfoque terapéutico de la deshidratación en pacientes con cáncer terminal. Med Paliat 3(2):59–66
16.
go back to reference González Barón M, Andreu Rodríguez M, Ordóñez Gallego A (2001) La astenia en el paciente con cáncer. Rev Oncologica 3:292–299 González Barón M, Andreu Rodríguez M, Ordóñez Gallego A (2001) La astenia en el paciente con cáncer. Rev Oncologica 3:292–299
17.
go back to reference González Barón M, Jalón JJ y Feliu J (1996) Definición del enfermo terminal y preterminal. In: González Barón M, Ordóñez A, Feliú J, Zamora P, Espinosa E. Tratado de Medicina Paliativa y tratamiento de soporte del enfermo con cáncer. Editorial PANAMERICANA, pp. 1083–1090 González Barón M, Jalón JJ y Feliu J (1996) Definición del enfermo terminal y preterminal. In: González Barón M, Ordóñez A, Feliú J, Zamora P, Espinosa E. Tratado de Medicina Paliativa y tratamiento de soporte del enfermo con cáncer. Editorial PANAMERICANA, pp. 1083–1090
18.
go back to reference Grond S, Zech D, Schug SA, Lynch J, Lehmann A (1991) Validation of world health organization guidelines for cancer pain relief during the last days and hours of life. J Pain Symptom Manage 6(7):411–422PubMedCrossRef Grond S, Zech D, Schug SA, Lynch J, Lehmann A (1991) Validation of world health organization guidelines for cancer pain relief during the last days and hours of life. J Pain Symptom Manage 6(7):411–422PubMedCrossRef
19.
go back to reference Grond S, Zech D, Diefenbach C, Bischoff A (1994) Prevalence and pattern of symptoms in patients with cancer pain: a prospective evaluation of 1635 cancer patients referred to a pain clinic. J Pain Symptom Manage 9(6):372–382PubMedCrossRef Grond S, Zech D, Diefenbach C, Bischoff A (1994) Prevalence and pattern of symptoms in patients with cancer pain: a prospective evaluation of 1635 cancer patients referred to a pain clinic. J Pain Symptom Manage 9(6):372–382PubMedCrossRef
20.
go back to reference Hockley JM, Dunlop R, Davies RJ (1988) Survey of distressing symptoms in dying patients and their families in hospital and the response to a symptom control team. Br Med J 296:1715–1717 Hockley JM, Dunlop R, Davies RJ (1988) Survey of distressing symptoms in dying patients and their families in hospital and the response to a symptom control team. Br Med J 296:1715–1717
21.
22.
go back to reference Kurtz ME, Given B, Kurtz JC, Given CW (1994) The interaction of age, symptoms, and survival status on physical and mental health of patients with cancer and their families. Cancer Sup 74(7):2071–2078CrossRef Kurtz ME, Given B, Kurtz JC, Given CW (1994) The interaction of age, symptoms, and survival status on physical and mental health of patients with cancer and their families. Cancer Sup 74(7):2071–2078CrossRef
23.
go back to reference Lloyd-Williams M, Dennis M, Taylor F (2004) A prospective study to determine the association between physical symptoms and depression in patients with advanced cancer. Palliat Med 18:558–563PubMedCrossRef Lloyd-Williams M, Dennis M, Taylor F (2004) A prospective study to determine the association between physical symptoms and depression in patients with advanced cancer. Palliat Med 18:558–563PubMedCrossRef
24.
go back to reference Lobo A, Chamorro L, Luque A (2002) Validación de las versiones en español de la Montgomery–Asberg depression rating scale y la Hamilton Anxiety Rating Scale para la evaluación de la depresión y de la ansiedad. Med Clin (Barc) 118(13):493–499 Lobo A, Chamorro L, Luque A (2002) Validación de las versiones en español de la Montgomery–Asberg depression rating scale y la Hamilton Anxiety Rating Scale para la evaluación de la depresión y de la ansiedad. Med Clin (Barc) 118(13):493–499
25.
go back to reference Maltoni M, Pirovano M, Nanni O, Marinari M, Indelli M, Granazio A, Terzoli E, Luzzani M, De Marinis F, Caraceni A, Labianca R (1997) Biological indices predictive of survival in 519 Italian terminally ill cancer patients. Italian multicenter study group on palliative care. J Pain Symptom Manage 13(1):1–9PubMedCrossRef Maltoni M, Pirovano M, Nanni O, Marinari M, Indelli M, Granazio A, Terzoli E, Luzzani M, De Marinis F, Caraceni A, Labianca R (1997) Biological indices predictive of survival in 519 Italian terminally ill cancer patients. Italian multicenter study group on palliative care. J Pain Symptom Manage 13(1):1–9PubMedCrossRef
26.
go back to reference Maltoni M, Pirovano M, Scarpi E, Marinari M, Indelli M, Arnoldi E, Galluci M, Frontini L, Piva L, Amadori D (1995) Prediction of survival of patients terminally ill with cancer. Cancer 75(10):2613–2622PubMedCrossRef Maltoni M, Pirovano M, Scarpi E, Marinari M, Indelli M, Arnoldi E, Galluci M, Frontini L, Piva L, Amadori D (1995) Prediction of survival of patients terminally ill with cancer. Cancer 75(10):2613–2622PubMedCrossRef
27.
28.
go back to reference Morasso G, Capelli MM, Viterbori P, Di Leo S, Alberisio A, Constantini M, Fiore M, Saccani D, Zeitler G, Verzolatto N, Tirelli W, Lazzari L, Partinico M, Borzoni G, Savian C, Obertino E, Zotti P, Ivaldi GP, Henriquet F (1999) Psychological and symptom distress in terminal cancer patients with met and unmet needs. J Pain Symptom Manage 17(6):402–409PubMedCrossRef Morasso G, Capelli MM, Viterbori P, Di Leo S, Alberisio A, Constantini M, Fiore M, Saccani D, Zeitler G, Verzolatto N, Tirelli W, Lazzari L, Partinico M, Borzoni G, Savian C, Obertino E, Zotti P, Ivaldi GP, Henriquet F (1999) Psychological and symptom distress in terminal cancer patients with met and unmet needs. J Pain Symptom Manage 17(6):402–409PubMedCrossRef
29.
go back to reference Morris JN, Suissa S, Sherwood S, Wright SM, Greer D (1986) Last days: a study of the quality of life of terminally ill cancer patients. J Chron Dis 39(1):47–62PubMedCrossRef Morris JN, Suissa S, Sherwood S, Wright SM, Greer D (1986) Last days: a study of the quality of life of terminally ill cancer patients. J Chron Dis 39(1):47–62PubMedCrossRef
30.
go back to reference Müller MJ, Szegedi A, Wetzel H, Benkert O (2000) Moderate and severe depression gradations for the Montgomery–Asberg depression rating scale. J Affective Disorders 60:137–140CrossRef Müller MJ, Szegedi A, Wetzel H, Benkert O (2000) Moderate and severe depression gradations for the Montgomery–Asberg depression rating scale. J Affective Disorders 60:137–140CrossRef
31.
go back to reference Passik SD, Dugan W, McDonald MV, Rosenfeld B, Theobald DE, Edgerton S (1998) Oncologists’ recognition of depression in their patients with cancer. J Clin Oncol 16(4):1594–600PubMed Passik SD, Dugan W, McDonald MV, Rosenfeld B, Theobald DE, Edgerton S (1998) Oncologists’ recognition of depression in their patients with cancer. J Clin Oncol 16(4):1594–600PubMed
32.
go back to reference Pirovano M, Maltoni M, Nanni O, Marinari M, Indelli M, Zaninetta G, Petrella V, Barni S, Zecca E, Scarpi E, Labianca R, Amadori D, Luporini G (1999) A new palliative prognostic score: a first step for the staging of terminally ill cancer patients. J Pain Symptom Manage 17(4):231–239PubMedCrossRef Pirovano M, Maltoni M, Nanni O, Marinari M, Indelli M, Zaninetta G, Petrella V, Barni S, Zecca E, Scarpi E, Labianca R, Amadori D, Luporini G (1999) A new palliative prognostic score: a first step for the staging of terminally ill cancer patients. J Pain Symptom Manage 17(4):231–239PubMedCrossRef
33.
go back to reference Portenoy RK, Thaler HT, Kornblith AB, McCarthy Lepore J, Friedlander-Klar H, Kiyasu E, Sobel K, Coyle N, Kemeny N, Norton L, Scher H (1994) The Memorial Symptom Assessment Scale: an instrument for the evaluation of symptom prevalence, characteristics and distress. Eur J Cancer 30(A):1326–1336CrossRef Portenoy RK, Thaler HT, Kornblith AB, McCarthy Lepore J, Friedlander-Klar H, Kiyasu E, Sobel K, Coyle N, Kemeny N, Norton L, Scher H (1994) The Memorial Symptom Assessment Scale: an instrument for the evaluation of symptom prevalence, characteristics and distress. Eur J Cancer 30(A):1326–1336CrossRef
34.
go back to reference Portenoy RK, Thaler HT, Kornblith AB, Lepore JM, Friedlander-Klar H, Coyle N, Smart-Curley T, Kemeny N, Norton L, Hoskins W (1994) Symptom prevalence, characteristics and distress in a cancer population. Qual Life Res 3(3):183–189PubMedCrossRef Portenoy RK, Thaler HT, Kornblith AB, Lepore JM, Friedlander-Klar H, Coyle N, Smart-Curley T, Kemeny N, Norton L, Hoskins W (1994) Symptom prevalence, characteristics and distress in a cancer population. Qual Life Res 3(3):183–189PubMedCrossRef
35.
go back to reference Reich WT (1995) El arte de cuidar a los moribundos. En Morir con dignidad: dilemas éticos al final de la vida. Fundación Ciencias de la Salud Reich WT (1995) El arte de cuidar a los moribundos. En Morir con dignidad: dilemas éticos al final de la vida. Fundación Ciencias de la Salud
36.
go back to reference Reuben DB, Vincent M, Hiris J (1988) Clinical symptoms and length of survival in patients with terminal cancer. Arch Intern Med 148:1586–1591PubMedCrossRef Reuben DB, Vincent M, Hiris J (1988) Clinical symptoms and length of survival in patients with terminal cancer. Arch Intern Med 148:1586–1591PubMedCrossRef
37.
go back to reference Roila F, Lupattelli M, Sassi M, Basurto C, Bracarda S, Picciafuoco M, Boschetti E, Milella G, Ballatori E, Tonato M, Del Favero A (1991) Intra and interobserver variability in cancer patients’ performance status assessed according to Karnofsky and ECOG scales. Ann Oncol 2(6):437–439PubMed Roila F, Lupattelli M, Sassi M, Basurto C, Bracarda S, Picciafuoco M, Boschetti E, Milella G, Ballatori E, Tonato M, Del Favero A (1991) Intra and interobserver variability in cancer patients’ performance status assessed according to Karnofsky and ECOG scales. Ann Oncol 2(6):437–439PubMed
38.
go back to reference Salud A, Martínez JM, Arnau N (1996) Estudio descriptivo de pacientes terminales ingresados en una unidad socio-sanitaria ubicada en un hospital de agudos. Med Paliat 3(2):53–58 Salud A, Martínez JM, Arnau N (1996) Estudio descriptivo de pacientes terminales ingresados en una unidad socio-sanitaria ubicada en un hospital de agudos. Med Paliat 3(2):53–58
39.
go back to reference Sarhill N, Mahmoud F, Christie R, Tahir A (2003) Assessment of nutritional status and fluid deficits in advanced cancer. Am J Hospice Palliat Care 20(6):465–473CrossRef Sarhill N, Mahmoud F, Christie R, Tahir A (2003) Assessment of nutritional status and fluid deficits in advanced cancer. Am J Hospice Palliat Care 20(6):465–473CrossRef
40.
go back to reference Schuit KW, Sleijfer DT, Meijler WJ, Otter R, Schakenraad J, Van den Bergh FC, Meyboom-de Jong B (1998) Symptoms and functional status of patients with disseminated cancer visiting outpatient departments. J Pain Symptom Manage 16(5):290–297PubMedCrossRef Schuit KW, Sleijfer DT, Meijler WJ, Otter R, Schakenraad J, Van den Bergh FC, Meyboom-de Jong B (1998) Symptoms and functional status of patients with disseminated cancer visiting outpatient departments. J Pain Symptom Manage 16(5):290–297PubMedCrossRef
41.
go back to reference Schwartz MK (1992) Enzymes as prognostic markers and therapeutic indicators in patients with cancer. Clin Chim Acta 206:77–82PubMedCrossRef Schwartz MK (1992) Enzymes as prognostic markers and therapeutic indicators in patients with cancer. Clin Chim Acta 206:77–82PubMedCrossRef
42.
go back to reference Shelkey M, Wallace M (1999) Katz index of independence in activities of daily living. J Gerontol Nurs 25(3):8–9PubMed Shelkey M, Wallace M (1999) Katz index of independence in activities of daily living. J Gerontol Nurs 25(3):8–9PubMed
43.
go back to reference Snaith RP, Harrop FM, Newby DA, Teale C (1986) Grade scores of the Montgomery–Asberg depression and the clinical anxiety scales. Br J Psychiatry 148:599–601PubMedCrossRef Snaith RP, Harrop FM, Newby DA, Teale C (1986) Grade scores of the Montgomery–Asberg depression and the clinical anxiety scales. Br J Psychiatry 148:599–601PubMedCrossRef
44.
go back to reference Spitzer WO, Dobson AJ, Hall A, Chesterman E, Levi J, Shepherd R, Battista RN, Catchlove BR (1981) Measuring the quality of life of cancer patients: a concise QL-index for use by physicians. J Chron Dis 34:585–597PubMedCrossRef Spitzer WO, Dobson AJ, Hall A, Chesterman E, Levi J, Shepherd R, Battista RN, Catchlove BR (1981) Measuring the quality of life of cancer patients: a concise QL-index for use by physicians. J Chron Dis 34:585–597PubMedCrossRef
45.
go back to reference Strömgren AS, Groenvold M, Sorensen A, Andersen L (2001) Symptom recognition in advanced cancer. A comparison of nursing records against patient self-rating. Acta Anesthesiol Scand 45(9):1080–1085CrossRef Strömgren AS, Groenvold M, Sorensen A, Andersen L (2001) Symptom recognition in advanced cancer. A comparison of nursing records against patient self-rating. Acta Anesthesiol Scand 45(9):1080–1085CrossRef
46.
go back to reference Tay WKJ, Shaw RJ, Goh CR (1994) A survey of symptoms in hospice patients in Singapore. Ann Acad Med 23(2):191–196 Tay WKJ, Shaw RJ, Goh CR (1994) A survey of symptoms in hospice patients in Singapore. Ann Acad Med 23(2):191–196
47.
go back to reference Vainio A (1991) Prevalence of symptoms in cancer. Palliat Med 1991 5:275–276CrossRef Vainio A (1991) Prevalence of symptoms in cancer. Palliat Med 1991 5:275–276CrossRef
48.
go back to reference Vainio A, Auvinen A (1996) Prevalence of symptoms among patients with advanced cancer: an international collaborative study. J Pain Symptom Manage 12(1):3–10PubMedCrossRef Vainio A, Auvinen A (1996) Prevalence of symptoms among patients with advanced cancer: an international collaborative study. J Pain Symptom Manage 12(1):3–10PubMedCrossRef
49.
go back to reference Verger E, Conill C, Chicote S, Azpiazu P (1993) Valor del Índice de Karnofsky como indicador del pronóstico de vida en pacientes oncológicos en fase terminal. Med Clin (Barc) 100(2):74 Verger E, Conill C, Chicote S, Azpiazu P (1993) Valor del Índice de Karnofsky como indicador del pronóstico de vida en pacientes oncológicos en fase terminal. Med Clin (Barc) 100(2):74
50.
go back to reference Verger E, Salamero M, Conill C (1992) Can Karnofsky performance status be transformed to the Eastern Cooperative Oncology Group Scoring Scale and viceversa? Eur J Cancer 28 A(8–9):1328–1330CrossRef Verger E, Salamero M, Conill C (1992) Can Karnofsky performance status be transformed to the Eastern Cooperative Oncology Group Scoring Scale and viceversa? Eur J Cancer 28 A(8–9):1328–1330CrossRef
51.
go back to reference Vigano A, Bruera E, Jhangri GS, Newman SC, Fields AL, Suarez-Almazor ME (2000) Clinical survival predictors in patients with advanced cancer. Arch Intern Med 160(6):861–868PubMedCrossRef Vigano A, Bruera E, Jhangri GS, Newman SC, Fields AL, Suarez-Almazor ME (2000) Clinical survival predictors in patients with advanced cancer. Arch Intern Med 160(6):861–868PubMedCrossRef
52.
go back to reference Waller A, Hershkowitz M, Adunsky A (1994) The effect of intravenous fluid infusion on blood and urine parameters of hydration and on state of consciousness in terminal cancer patients. Am J Hospice Palliat Care, 22–27 Nov–Dec Waller A, Hershkowitz M, Adunsky A (1994) The effect of intravenous fluid infusion on blood and urine parameters of hydration and on state of consciousness in terminal cancer patients. Am J Hospice Palliat Care, 22–27 Nov–Dec
54.
go back to reference Wharton RH (2002) Sleeping with the enemy: treatment of fatigue in individuals with cancer. The Oncologist 7:96–99PubMedCrossRef Wharton RH (2002) Sleeping with the enemy: treatment of fatigue in individuals with cancer. The Oncologist 7:96–99PubMedCrossRef
55.
go back to reference Zung WK (1971) A rating instrument for anxiety disorders. Psychosomatics XII:371–379 Zung WK (1971) A rating instrument for anxiety disorders. Psychosomatics XII:371–379
Metadata
Title
Descriptive analysis of clinical factors affecting terminally ill cancer patients
Authors
A. M. Jiménez-Gordo
J. Feliu
B. Martínez
J. de-Castro
N. Rodríguez-Salas
N. Sastre
Y. Vilches
E. Espinosa
J. R. Rodríguez-Aizcorbe
M. González-Barón
Publication date
01-03-2009
Publisher
Springer-Verlag
Published in
Supportive Care in Cancer / Issue 3/2009
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-008-0460-y

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