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Symptom Prevalence, Intensity, and Distress in Patients With Inoperable Lung Cancer in Relation to Time of Death

Carol Tishelman, Lena-Marie Petersson, Lesley F. Degner, Mirjam A.G. Sprangers

From the Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet; Research and Development Unit, Stockholms Sjukhem Foundation, Stockholm, Sweden; Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; University of Manchester, School of Nursing, Midwifery and Social Work, Manchester, United Kingdom; and the Faculty of Nursing, Helen Glass Center for Nursing, University of Manitoba, Winnipeg, Manitoba, Canada

Address reprint requests to Carol Tishelman, PhD, RN, Research & Development Unit, Stockholms Sjukhem Foundation, Mariebergsgatan 22, 112 35 Stockholm, Sweden; e-mail: carol.tishelman{at}ki.se

Purpose To examine symptom prevalence, intensity, and association with distress in patients with inoperable lung cancer (LC), using time to death as point of reference.

Patients and Methods A consecutive sample of 400 patients completed the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 plus a 13-item LC-specific scale and the Thurstone Scale of Symptom Distress–Lung Cancer at six time points during the first year after diagnosis. Patients were divided into subgroups, using data from the time point closest to death (< 1; 1 to 2; > 2 to 3; > 3 to 6; > 6 to 12; and > 12 months before death) for analysis.

Results More than 50% of patients in all subgroups reported problems related to physical, role, and emotional functioning; fatigue; dyspnea; and cough. In general, functional levels were lower and symptoms higher in subgroups closer to death. Notably, clinically relevant differences were also found in role and social functioning and appetite loss between the two groups furthest from death. A consistent pattern was found among the six subgroups, with breathing, pain, and fatigue rated as the symptoms most associated with distress.

Conclusion High prevalence of symptoms was found in all subgroups, with higher intensity in subgroups closer to death, indicating a need for prophylactic and proactive symptom management. Less concordance was found among symptom prevalence, intensity, and association with distress in subgroups further from death. Future studies should investigate longitudinal associations between symptoms with low intensity and high distress, and examine their clinical implications.

Supported by the Swedish National Research Council, Swedish Cancer Society, Swedish Heart-Lung Foundation, Swedish Foundation for Health Care Sciences and Allergy Research, and the Center for Health Care Sciences at the Karolinska Institutet.

This study derives from a larger research project with other portions presented in Broberger E, Tishelman C, von Essen L: J Pain Symptom Manage 29:572-583, 2005; Tishelman C, Degner LF, Rudman A, et al: Cancer 104:2013-2021, 2005; Broberger E, Sprangers M, Tishelman, C: Nurs Res 55:274-282, 2006; and Leveälahti H, Tishelman C, Öhlén J: Psycho-oncology 10.1002/pon.1080.

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

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