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01-01-2020 | Nausea | Original Article

Symptom correlates of dyspnea in advanced cancer patients using the Edmonton Symptom Assessment System

Authors: Erin McKenzie, Liying Zhang, Stephanie Chan, Pearl Zaki, Yasmeen Razvi, May Tsao, Elizabeth Barnes, Leah Drost, Caitlin Yee, Matthew Hwang, Carlo DeAngelis, Edward Chow

Published in: Supportive Care in Cancer | Issue 1/2020

Abstract

Purpose

Dyspnea is frequently experienced in advanced cancer patients and is associated with poor prognosis and functional decline. This study used the Edmonton Symptom Assessment System (ESAS) to characterize the relationship between dyspnea and concurrent symptoms experienced by advanced cancer patients.

Methods

A prospective database was collected and analyzed to extract patient demographics and ESAS scores. Logistic regression analysis and generalized estimating equations (GEE) identified correlations of other ESAS symptoms in three categories: severity of dyspnea (none, mild, moderate, severe), moderate/severe dyspnea (ESAS ≥ 4), and presence of dyspnea (ESAS ≥ 1), at patients’ first visit and over time, respectively.

Results

Multivariable analysis revealed drowsiness (p = 0.001), and anxiety (p = 0.01) and appetite loss (p = 0.02) were associated with increased severity of dyspnea at first visit. Over time, tiredness (p = 0.02), drowsiness (p = 0.04), nausea (p = 0.02), and anxiety (p = 0.0006) were more likely to experience increased dyspnea severity. Tiredness (p = 0.0003), depression (p = 0.03), and appetite loss (p = 0.003) were significant for moderate/severe dyspnea at first visit. Over multiple visits, tiredness (p < 0.0001), anxiety (p = 0.0008), and appetite loss (p = 0.0008) had higher probabilities of moderate/severe dyspnea. For the presence of dyspnea at the first visit, anxiety (p = 0.03) and drowsiness (p = 0.002) were significantly correlated with an increased frequency of dyspnea. Over time, anxiety (p < 0.0001) and drowsiness (p < 0.0001) remained significant with the addition of nausea (p = 0.0007).

Conclusions

The highly interactive relationship between dyspnea and other common cancer symptoms necessitates the development of comprehensive symptom assessments and utilization of multimodal management approaches that consider concurrent symptoms for improved identification and treatment of dyspnea.

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Title: Symptom correlates of dyspnea in advanced cancer patients using the Edmonton Symptom Assessment System
Authors: Erin McKenzie
Liying Zhang
Stephanie Chan
Pearl Zaki
Yasmeen Razvi
May Tsao
Elizabeth Barnes
Leah Drost
Caitlin Yee
Matthew Hwang
Carlo DeAngelis
Edward Chow
Publication date: 01-01-2020
Publisher: Springer Berlin Heidelberg
Keywords: Nausea
Mood Disorders
Dyspnea
Affective Disorder
Dyspnea
Anxiety
Published in: Supportive Care in Cancer / Issue 1/2020
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-019-04787-0

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