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Symptom Distress, Including Pain, Predicts Lung Ca Survival

Symptom Distress, Including Pain, Predicts Lung Ca Survival

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 10:423-431, 1995).

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 survival times.

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 survival.

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