WINNIPEG, Canada-Clinical trials have shown that the level of
symptom distress at the time of lung cancer diagnosis can predict
survival, and now a study performed in an ambulatory setting has
confirmed this finding. Patients with higher symptom distress
scores are likely to die more quickly than those with lower scores,
report University of Manitoba researchers Lesley F. Degner, RN,
PhD, and Jeffrey A. Sloan, PhD.
They note that clinicians can use this information to counsel
patients and families and discuss life completion issues. In addition,
the data raise the interesting question of whether interventions
to palliate symptoms could influence survival.
The study involved 434 newly diagnosed cancer patients from two
clinics in Winnipeg, including 82 with lung cancer. Only 13% of
the sample had been offered clinical trials, and 10% accepted.
Patients completed a symptom distress measure consisting of 13
symptoms and scaled from 1 (normal or no distress) to 5 (severe
distress). Survival analysis was conducted 5 years after the start
of the initial data collection, at which time only 13 of the original
82 lung cancer patients were alive.
Overall, symptom distress was very low in this group, with a mean
score of 23.06 out of a theoretical range of 13 to 65. The most
troubling symptoms were fatigue, which nearly 40% of patients
scored as 3, 4, or 5; insomnia, with about 30% having high scores;
and pain, with about 25% reporting distress (J Pain Symptom Manage
For lung cancer patients, the correlation between symptom distress
and time of survival from diagnosis was -0.49
(P = .0001). Although there were patients with low symptom
distress who had both short and long survival times, virtually
all of the patients with high symptom distress scores had short
Of the three outliers (lung cancer patients with high distress
close to time of diagnosis but who were still alive at 5 years),
chart review showed that their complaints involved pain in their
thoracotomy scars and/or general surgical site.
"The symptom distress scale is obviously sensitive to the
effects of postsurgical distress, and, as a result, its usefulness
in predicting survival is reduced for such patients," Drs.
Degner and Sloan note.
The investigators conclude that measuring symptom distress could
help identify lung cancer patients with high distress who may
have shortened survival regardless of treatment. Such knowledge
can be used to ensure that these patients receive appropriate
palliation and end-of-life counseling. Intervention studies are
needed, they say, to determine whether palliation can increase