Journal Article

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

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

2020

Overview

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.

• Publisher: Springer Berlin Heidelberg,Springer,Springer Nature B.V
• Subject: Adult / Aged / Aged, 80 and over / Analysis / Anxiety / Appetite loss / Cancer / Cancer patients / Care and treatment / Databases, Factual / Demography / Disease Progression / Dyspnea / Dyspnea - diagnosis / Dyspnea - etiology / Dyspnea - pathology / Evaluation / Female / Functional impairment / Humans / Male / Medical prognosis / Medicine / Medicine & Public Health / Mental depression / Middle Aged / Nausea / Neoplasms - complications / Neoplasms - diagnosis / Neoplasms - pathology / Neoplasms - therapy / Nursing / Nursing Research / Oncology / Original Article / Pain Medicine / Palliative care / Palliative Care - methods / Patients / Practitioner patient relationship / Prognosis / Quality of life / Regression analysis / Rehabilitation Medicine / Retrospective Studies / Risk Factors / Severity / Severity of Illness Index / Sleepiness / Symptom Assessment - methods / Symptom management / Terminally Ill / Young Adult