BACKGROUND: Patients with advanced cancer frequently experience distressful symptoms and receive numerous medications. We describe the symptomatology and medication profile of ambulatory cancer patients receiving exclusively supportive care at the Princess Margaret Hospital. MATERIALS AND METHODS: This was a retrospective, cross-sectional study. We reviewed the charts of consecutive adult cancer patients attending palliative care clinics and who were no longer receiving cancer-directed therapy. From the medical records, we collected information about self-reported symptoms [screened for with the numerical Edmonton symptom assessment system (ESAS) scale; range, 0-10, with 10=worst symptom] and medication profiles. Summary statistics were used to describe the results. RESULTS: Two hundred fifty five patients met the inclusion criteria. The most frequent self-reported symptoms of any severity were fatigue (77%), pain (75%), and lack of appetite (66%). These were also the most severe symptoms: fatigue (median ESAS score=7), pain (median ESAS=5), and lack of appetite (median ESAS=5). The median number of medications per patient after consultation in the palliative care service was 6, and the most common classes of drugs prescribed were opioids (67%), laxatives/stool softeners (54%), corticosteroids (41%), and acetaminophen (41%). Palliative care physicians made at least one medication change in 75% of the patients, with the most frequent change being the addition of new medication(s); dexamethasone was the most commonly added individual drug (18% of the patients). CONCLUSION: Among patients with advanced cancer not receiving antineoplastic therapy, the most frequent and severe symptoms were fatigue, pain, and lack of appetite. The medication profile represented drugs that could both alleviate and contribute to these symptoms. Audit of patient symptoms and medication prescription in palliative care may inform clinical practice and help the development of research specific to patient symptoms.
BACKGROUND:Patients with advanced cancer frequently experience distressful symptoms and receive numerous medications. We describe the symptomatology and medication profile of ambulatory cancerpatients receiving exclusively supportive care at the Princess Margaret Hospital. MATERIALS AND METHODS: This was a retrospective, cross-sectional study. We reviewed the charts of consecutive adult cancerpatients attending palliative care clinics and who were no longer receiving cancer-directed therapy. From the medical records, we collected information about self-reported symptoms [screened for with the numerical Edmonton symptom assessment system (ESAS) scale; range, 0-10, with 10=worst symptom] and medication profiles. Summary statistics were used to describe the results. RESULTS: Two hundred fifty five patients met the inclusion criteria. The most frequent self-reported symptoms of any severity were fatigue (77%), pain (75%), and lack of appetite (66%). These were also the most severe symptoms: fatigue (median ESAS score=7), pain (median ESAS=5), and lack of appetite (median ESAS=5). The median number of medications per patient after consultation in the palliative care service was 6, and the most common classes of drugs prescribed were opioids (67%), laxatives/stool softeners (54%), corticosteroids (41%), and acetaminophen (41%). Palliative care physicians made at least one medication change in 75% of the patients, with the most frequent change being the addition of new medication(s); dexamethasone was the most commonly added individual drug (18% of the patients). CONCLUSION: Among patients with advanced cancer not receiving antineoplastic therapy, the most frequent and severe symptoms were fatigue, pain, and lack of appetite. The medication profile represented drugs that could both alleviate and contribute to these symptoms. Audit of patient symptoms and medication prescription in palliative care may inform clinical practice and help the development of research specific to patient symptoms.
Authors: Camilla Zimmermann; Dori Seccareccia; Allyson Clarke; David Warr; Gary Rodin Journal: Support Care Cancer Date: 2006-06-27 Impact factor: 3.603
Authors: J Bernhard; D F Cella; A S Coates; L Fallowfield; P A Ganz; C M Moinpour; P Mosconi; D Osoba; J Simes; C Hürny Journal: Stat Med Date: 1998 Mar 15-Apr 15 Impact factor: 2.373
Authors: Fredrick D Ashbury; Lisa Madlensky; Peter Raich; Mark Thompson; Geoff Whitney; Ken Hotz; Boris Kralj; William S Edell Journal: Support Care Cancer Date: 2003-03-06 Impact factor: 3.603
Authors: Camilla B Pimentel; Jerry H Gurwitz; Jennifer Tjia; Anne L Hume; Kate L Lapane Journal: J Am Geriatr Soc Date: 2016-08-03 Impact factor: 5.562
Authors: Camilla Zimmermann; Debika Burman; Shazeen Bandukwala; Dori Seccareccia; Ebru Kaya; John Bryson; Gary Rodin; Christopher Lo Journal: Support Care Cancer Date: 2009-07-23 Impact factor: 3.603
Authors: Julian Lindsay; Michael Dooley; Jennifer Martin; Michael Fay; Alison Kearney; Michael Barras Journal: Support Care Cancer Date: 2013-12-21 Impact factor: 3.603