Severe symptoms and very low quality-of-life among outpatients newly diagnosed with advanced cancer: data from a multicenter cohort study

Abstract

Purpose: The aim of this study was to identify symptoms of severe intensity or very low scores for quality of life (QoL) domains in newly diagnosed outpatients with advanced cancer.

Methods: This multicenter cohort study from a state-wide palliative care network included adult outpatients with advanced cancer diagnosed within the preceding 8 weeks from four comprehensive cancer centers (DRKS00006162, registered on 19 May 2014). We used the Palliative Outcome Scale (POS), Hospital Anxiety and Depression Scale, and European Organization for Research and Treatment of Cancer QoL Questionnaire-C30. For each questionnaire, cut-off scores defined symptoms and QoL domains that were considered "severe" or "very low."

Results: Of 3155 patients screened, 481/592 (81.3%) were analyzed (mean age 62.4; women n = 245, 50.9%). We identified 324/481 (67.4%) patients experiencing at least one severe symptom or a very low QoL domain (median 2; range 0 to 16). Role functioning (n = 180, 37.4%), fatigue (n = 162, 33.7%), and social functioning (n = 126, 26.2%) were most commonly affected. QoL was very low in 89 patients (18.5%). Women experienced more anxiety symptoms, fatigue, and had lower POS scores. Patients often mentioned physical symptoms and fears of adverse events resulting from disease-modifying therapies (e.g., chemotherapy) as most relevant problems.

Conclusions: Already within the first 8 weeks after diagnosis, the majority of patients reported at least one severe symptom or a very low QoL domain. Gender differences were evident. The findings illustrate the value of early routine assessment of patient burden and the development of multi-professional and interdisciplinary palliative care.

Keywords: Early palliative care; Neoplasms; Palliative care; Quality of life; Symptom assessment.

Fig. 1

Flow diagram

Fig. 2

Number of patients per burden. x-axis, number of “severe burden”; y-axis, number of patients

Fig. 3

Number of patients crossing the cut-off of severe burden per item. Patients with at least one severe burden were defined according to the following criteria: POS > 30 or HADS Anxiety or Depression score 15 to 21 (“severe”) or global health status/quality of life-item, physical functioning, role functioning, emotional functioning, cognitive functioning, or social functioning of the EORTC QLQ-C30 0 to 25 or fatigue or nausea/vomiting of the EORTC QLQ-C30 76 to 100 or maximum burden (= 100) in the symptoms pain, dyspnea, insomnia, appetite loss, constipation, diarrhea, or financial problems of the EORTC QLQ-C30