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Suffering With Advanced Cancer

Keith G. Wilson, Harvey Max Chochinov, Christine J. McPherson, Katerine LeMay, Pierre Allard, Srini Chary, Pierre R. Gagnon, Karen Macmillan, Marina De Luca, Fiona O'Shea, David Kuhl, Robin L. Fainsinger

From The Rehabilitation Centre, The Ottawa Hospital; Élisabeth Bruyère Research Institute, SCO Health Service; School of Psychology; Department of Medicine, University of Ottawa, Ottawa, ON; Department of Psychiatry, University of Manitoba, Winnipeg, MB; Department of Family Medicine, University of Saskatchewan, Saskatoon, SK; Faculty of Pharmacy, Université Laval, Québec, QC; Grey Nuns Community Hospital; Department of Oncology, University of Alberta, Edmonton, AB; British Columbia Cancer Agency–Cancer Centre for the Southern Interior, Kelowna; Department of Family and Community Medicine, University of British Columbia, Vancouver, BC; and Dr H Bliss Murphy Cancer Centre, St John's, NL, Canada

Address reprint requests to Keith G. Wilson, PhD, The Rehabilitation Centre, The Ottawa Hospital, 505 Smyth Rd, Ottawa, ON, Canada K1H 8M2; e-mail: kewilson{at}ottawahospital.on.ca

Purpose The alleviation of suffering is a central goal of palliative care, but little research has addressed the construct of suffering as a global experience of the whole person. We inquired into the sense of suffering among patients with advanced cancer to investigate its causes and correlates.

Patients and Methods Semistructured interviews were administered to 381 patients. The interviews inquired about physical symptoms, social concerns, psychological problems, and existential issues. We also asked, "In an overall, general sense, do you feel that you are suffering?"

Results Almost half (49.3%) of respondents did not consider themselves to be suffering, and 24.9% felt that they suffered only mildly. However, 98 participants (25.7%) were suffering at a moderate-to-extreme level. The latter participants were more likely to experience significant distress on 20 of the 21 items addressing symptoms and concerns; the highest correlations were with general malaise (rho []= 0.56), weakness ( = 0.42), pain ( = 0.40), and depression ( = .39). In regression analyses, physical symptoms, psychological distress, and existential concerns, but not social issues, contributed to the prediction of suffering. In qualitative narratives, physical problems accounted for approximately half (49.5%) of patient reports of suffering, with psychological, existential, and social concerns accounting for 14.0%, 17.7%, and 18.8%, respectively.

Conclusion Many patients with advanced cancer do not consider themselves to be suffering. For those who do, suffering is a multidimensional experience related most strongly to physical symptoms, but with contributions from psychological distress, existential concerns, and social-relational worries.

Supported by a grant from the Canadian Institutes of Health Research (CIHR), and by a CIHR Institute of Aging New Emerging Team grant, "Optimizing End-of-Life-Care for Seniors." H.M.C. is a Tier 1 Canada Research Chair of the CIHR. P.R.G. is a Research Scientist of the National Cancer Institute of Canada with funds from the Canadian Cancer Society.

Presented in part at the 16th International Congress on Care of the Terminally Ill, September 27, 2006, Montreal, QC, Canada.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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