BOSTONFatigue is a worse problem than pain for most cancer patients
but oncologists rarely know this because discussions with patients about
symptom distress are typically "don’t ask, don’t tell."
Physicians don’t ask, and patients don’t tell, according to Marybeth
Singer, MS, RN.
This is particularly unfortunate, Ms. Singer noted, because data from a
survey of cancer patients at New England Medical Center in Boston, show that
just talking to a clinician about symptoms provided some relief of symptom
distress for most patients. Ms. Singer serves as nurse practitioner
coordinator in the New England Medical Center’s Division of
"Symptom distress is a major cause of diminished quality of life for
persons with cancer, and lack of assessment is a major barrier to
treatment," Ms. Singer said. This fact is widely recognized in the pain
literature but appears to apply to all of the more common symptoms
associated with cancer and cancer treatment.
Most Severe Symptoms
The survey found that fatigue and lack of energy were the most severe
symptoms regardless of type of cancer. Pain came in far down the list (see
"Lack of energy was the number one symptom regardless of
diagnosis," Ms. Singer said. When only symptoms rated 7 or higher on a
1-to-10 scale were considered, lack of energy was again the worst problem,
followed by negative quality of life and difficulties with activities of
daily living. Although 65% of patients had no symptoms in this severe range,
35% had had least one intense symptom.
Even patients who had severe symptoms rarely discussed them with their
physicians. Ms. Singer and colleagues contacted all 47 patients who had at
least one symptom with a score worse than 7. They completed telephone
interviews with 26 of these 47 patients. Only 29% of patients had discussed
the symptoms with their MD or nurse practitioner at their most recent visit.