August 2006

Dear Readers Here's the Article for this Month:

A comparison of symptom prevalence in far advanced Cancer, AIDS, Heart Disease, Chronic Obstructive Pulmonary Disease and Renal Disease

Author(s): Solano JP, Gomes B, Higginson IJ

Journal:  Journal of Pain and Symptom Management 2006; 31/1: 58-69

The authors carried out an analysis of the data in the literature regarding symptom prevalence in patients with life threatening diseases in order to compare the symptom profiles of cancer patients with those of non-cancer patients. A systematic search of medical databases and textbook chapters identified 64 original studies reporting the prevalence of 11 common symptoms (pain, depression, anxiety, confusion, fatigue, dyspnoea, insomnia, nausea, constipation, diarrhea, anorexia) among end-stage patients suffering from five common, chronic and progressive diseases such as cancer, AIDS, Heart Disease (HD), Chronic Obstructive Pulmonary Disease (COPD), and renal disease (RD).

The authors reported the minimum and maximum prevalence for each symptom within the five selected clinical conditions. However, anorexia and insomnia in AIDS patients, anxiety and diarrhea in HD patients and diarrhea in RD population had only one data source available and is therefore reported as a single prevalence. The high prevalence of symptoms in the cancer group is due to the much larger number of patients reported (from 2.888 to 10,379 patients) for each symptom compared to the other four diseases (ranging from 19 to 1435 patients). No data was obtained regarding the prevalence of confusion among RD patients or for nausea and diarrhea among COPD patients.

The maximum prevalence of pain is high in all of the diseases; however it was highest for cancer patients (96%) compared to all other diseases:

AIDS (80%),

HD (77%);

COPD (77%);

RD (50%).

In AIDS patients, the minimum prevalence of pain was the highest with respect to all other disease categories (63% vs 35% in cancer, 41% in HD, 34% in COPD, 47% in RD).

Of interest is that fatigue was present in all 5 disease categories; high percentages were found in cancer (32-90%), AIDS (54-85%), HD (69-82%), and COPD (68-80%). Patients who had renal disease had the highest minimum percentage (73%) and a very narrow range between the minimum and maximum.

The percentage for breathlessness varies from 10% to 70% in cancer; 11% to 62% in AIDS and RD, and reaches the highest levels in HD (60-88%) and COPD (90-95%).

Constipation is present in all the chronic illnesses particularly in RD patients (29-70%). Anorexia is also a common symptom in all the pathologies examined with cancer patients having the highest percentage (30-92%). Diarrhea is particularly frequent in AIDS patients (30-90%) compared to cancer patients (maximum 29%).

The highest percentages of depression were found in AIDS (10-82%) and cancer patients (3-77%); however COPD patients were also high (37-71%). COPD patients have a high percentage of anxiety (51-75% vs 13-79% in cancer patients).

This study shows there are a number of common symptoms found along the pathway to death in patients who have malignant or non malignant chronic illnesses.

Why I chose this article

This paper shows that the symptoms usually described in studies carried out on cancer patients are just as common and frequent in other chronic advanced pathologies. Whereas, a lot has been published regarding evaluation and treatment of oncologic patients, this is not true of other pathologies. Palliative care should be available to all patients based on their symptoms and not only on their prognosis.

Treatment of symptoms and palliative care are therefore to be considered a universal discipline in the medical field. Much therefore has to be done to train and update healthcare professionals, as well as, patients and their families about the need to have access to palliative care for everyone with uncontrolled symptoms.

Regards,

Carla Ripamonti, MD
Member of the Board of Directors, IAHPC