SAN FRANCISCOMore than one-third of cancer outpatients report two or
more symptoms such as pain, fatigue, nausea, depression, and sleep
disturbances. Because severity of individual symptoms and risk of clinical
depression both worsen as the number of symptoms increases, these symptom
clusters or groupings have important clinical implications, according to
Marylin J. Dodd, RN, PhD, professor of nursing at the University of
California at San Francisco.
Dr. Dodd reported data from a cross-sectional, descriptive study of
symptoms and comorbidities in 177 oncology patients recruited from three
outpatient settings. "The traditional approach to studying symptoms has
been to perform detailed assessments of individual symptoms," she said.
"However, clinical experience suggests that oncology outpatients
present with multiple symptoms and a variety of comorbid conditions. The
purposes of this study were to determine the prevalence of pain, fatigue,
and sleep disturbances in a sample of oncology patients and to determine the
prevalence of a number of common comorbid conditions." The study was
funded by the National Cancer Institute, Purdue Pharmaceutical, and Janssen
The average patient in the study population was 59.4 years old, female,
and had a Karnofsky score of 77.2. Patients were assessed using the
Wisconsin Brief Pain Inventory (BPI), the Lee Fatigue Scale (LFS), the
General Sleep Disturbance Scale (GSDS), the Center for Epidemiological
Studies Depression Scale (CES-D), and a checklist of common medical
Analysis of symptom groupings showed that fatigue and sleep disorders
both increased in prevalence and in severity as the number of symptoms the
patient reported increased. Worst reported pain levels were significantly
higher in patients with three or more symptoms compared to those with only
one symptom, and depression similarly increased as number of symptoms
increased from one to three.
Although 41.9% of the patients in this sample reported no symptoms, 34%
reported two or more symptoms (see Table 1).
High Rate of Comorbidities