Advertisement

Symptom hyper-expression in advanced cancer patients with anxiety and depression admitted to an acute supportive/palliative care unit

  • Sebastiano Mercadante
  • Claudio Adile
  • Patrizia Ferrera
  • Andrea Cortegiani
  • Alessandra Casuccio
Original Article
  • 34 Downloads

Abstract

Purpose

The aim of this study was to compare symptom expression in advanced cancer patients with depression and anxiety and in patients with no such symptoms.

Methods

Secondary analysis of a previous study assessing the role of an acute palliative supportive care unit (APSCU) in a comprehensive cancer center. Patients completed the Edmonton Symptom Assessment System (ESAS) at admission (T0) and 7 days after or at discharge (T7).

Results

Three hundred-fourteen consecutive cancer patients admitted to the APSCU were surveyed. Eighty-six and 66 patients improved their level of depression and anxiety, respectively (passing from ≥ 4 to 0–3, from T0 to T7), after that palliative care intervention resulted in a significant improvement of the other symptoms. Changes were statistically significant for both symptoms (P < 0.0005). Patients admitted for uncontrolled pain were more likely to be anxious, while patients admitted for other symptoms or end-of-life care were more likely to be depressed. The presence of anxiety and depression (≥ 4/10 on ESAS) was significantly associated with a higher level of symptom expression at admission and at T7 (P < 0.0005). In patients presenting both psychological symptoms, symptom expression was significantly more relevant in comparison with patients not reporting moderate-severe psychological symptoms. Pain and depression were independently associated with anxiety at T0. Variables independently associated with depression at T0 were drowsiness, appetite, and anxiety.

Conclusions

Psychological symptoms of ESAS concur to hyper-express some symptoms and make symptom control more difficult. A clear association between anxiety and depression exists.

Keywords

Advanced cancer Anxiety Depression Palliative care 

Notes

Compliance with ethical standards

The study was approved by the ethical committee and informed consent was obtained.

Conflict of interest

All authors declare that they have no conflict of interest.

References

  1. 1.
    Lloyd-Williams M, Shiels C, Taylor F, Dennis M (2009) Depression--an independent predictor of early death in patients with advanced cancer. J Affect Disord 113:127–132CrossRefGoogle Scholar
  2. 2.
    Lo C, Zimmermann C, Rydall A, Walsh A, Jones JM, Moore MJ, Shepherd FA, Gagliese L, Rodin G (2010) Longitudinal study of depressive symptoms in patients with metastatic gastrointestinal and lung cancer. J Clin Oncol 28:3084–3089CrossRefGoogle Scholar
  3. 3.
    Cheung WY, Barmala N, Zarinehbaf S, Rodin G, le LW, Zimmermann C (2009) The association of physical and psychological symptom burden with time to death among palliative cancer outpatients. J Pain Symptom Manag 37:297–304CrossRefGoogle Scholar
  4. 4.
    Ciaramella A, Poli P (2001) Assessment of depression among cancer patients: the role of pain, cancer type and treatment. Psychooncology 10:156–165CrossRefGoogle Scholar
  5. 5.
    Chochinov HM, Wilson KG, Enns M, Lander S (1997) “Are you depressed?” screening for depression in the terminally ill. Am J Psychiatry 154:674–676CrossRefGoogle Scholar
  6. 6.
    Katon W, Lin EHB, Kroenke K (2007) The association of depression and anxiety with medical symptom burden in patients with chronic medical illness. Gen Hosp Psychiatry 29:147–155CrossRefGoogle Scholar
  7. 7.
    Kroenke K, Rosmalen JGM (2006) Symptoms, syndromes, and the value of psychiatric diagnostics in patients who have functional somatic disorders. Med Clin North Am 90:603–626CrossRefGoogle Scholar
  8. 8.
    O'Connor M, Weir J, Butcher I et al (2012) Pain in patients attending a specialist cancer service: prevalence and association with emotional distress. J Pain Symptom Manag 43:29–38CrossRefGoogle Scholar
  9. 9.
    Brown LF, Kroenke K (2009) Cancer-related fatigue and its associations with depression and anxiety: a systematic review. Psychosomatics 50:440–447CrossRefGoogle Scholar
  10. 10.
    Zaza C, Baine N (2002) Cancer pain and psychosocial factors:a critical review of the literature. J Pain Symptom Manag 24:526–542CrossRefGoogle Scholar
  11. 11.
    Wasteson E, Brenne E, Higginson IJ, Hotopf M, Lloyd-Williams M, Kaasa S, Loge JH, the European Palliative Care Research Collaborative (EPCRC) (2009) Depression assessment and classification in palliative cancer patients: a systematic literature review. Palliat Med 23:739–753CrossRefGoogle Scholar
  12. 12.
    Fitzgerald P, Lo C, Li M, Gagliese L, Zimmermann C, Rodin G (2015) The relationship between depression and physical symptom burden in advanced cancer. BMJ Support Palliat Care 5:381–388CrossRefGoogle Scholar
  13. 13.
    Teunissen SCCM, de Graeff A, Voest EE, de Haes JCJM (2007) Are anxiety and depressed mood related to physical symptom burden? A study in hospitalized advanced cancer patients. Palliat Med 21:341–346CrossRefGoogle Scholar
  14. 14.
    Delgado-Guay M, Parsons HA, Li Z, Palmer JL, Bruera E (2009) Symptom distress in advanced cancer patients with anxiety and depression in the palliative care setting. Support Care Cancer 17:573–579CrossRefGoogle Scholar
  15. 15.
    Maltoni M, Caraceni A, Brunelli C, Broeckaert B, Christakis N, Eychmueller S, Glare P, Nabal M, Viganò A, Larkin P, de Conno F, Hanks G, Kaasa S, Steering Committee of the European Association for Palliative Care (2005) Prognostic factors in advanced cancer patients: evidence-based clinical recommendations- a study by the Steering Committee of the European Association for Palliative Care. J Clin Oncol 23:6240–6248CrossRefGoogle Scholar
  16. 16.
    Austin P, Wiley S, McEvoy PM, Archer L (2011) Depression and anxiety in palliative care inpatients compared with those receiving palliative care at home. Palliat Support Care 9:393–400CrossRefGoogle Scholar
  17. 17.
    Mercadante S, Adile C, Caruselli A, Ferrera P, Costanzi A, Marchetti P, Casuccio A (2016) The palliative-supportive care unit in a Comprehensive Cancer Center as crossroad for patients’ oncological pathway. PLoS One 11:e0157300CrossRefGoogle Scholar
  18. 18.
    Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K (1991) The Edmonton Symptom Assessment System (ESAS): a simple method for the assessment of palliative care patients. J Palliat Care 7:6–9PubMedGoogle Scholar
  19. 19.
    Hui D, Bruera E (2017) The Edmonton Symptom Assessment Scale remains useful for depression screening. Palliat Med 31:483–484CrossRefGoogle Scholar
  20. 20.
    Chang VT, Hwang SS, Feuerman M (2000) Validation of the Edmonton Symptom Assessment Scale. Cancer 88:2164–2171CrossRefGoogle Scholar
  21. 21.
    Rhondali W, Yennurajalingam S, Ferrer J, Chisholm G, Filbet M, Bruera E (2014) Association between supportive care interventions and patient self-reported depression among advanced cancer outpatients. Support Care Cancer 22:871–879CrossRefGoogle Scholar
  22. 22.
    Ripamonti CI, Bandieri E, Pessi MA, Maruelli A, Buonaccorso L, Miccinesi G (2014) The Edmonton Symptom Assessment System (ESAS) as a screening tool for depression and anxiety in non-advanced patients with solid or haematological malignancies on cure or follow-up. Support Care Cancer 22:783–793CrossRefGoogle Scholar
  23. 23.
    Modonesi C, Scarpi E, Maltoni M, Derni S, Fabbri L, Martini F, Sansoni E, Amadori D (2005) Impact of palliative care unit admission on symptom control evaluated by the Edmonton Symptom Assessment System. J Pain Symptom Manag 30:367–373CrossRefGoogle Scholar
  24. 24.
    Wakefield CE, Butow PN, Aaronson NA, Hack TF, Hulbert-Williams NJ, Jacobsen PB, International Psycho-Oncology Society Research Committee (2015) Patient-reported depression measures in cancer: a meta-review. Lancet Psychiatry 2:635–647CrossRefGoogle Scholar
  25. 25.
    Grotmol KS, Lie HC, Loge JH, Aass N, Haugen DF, Stone PC, Kaasa S, Hjermstad MJ (2018) Patients with advanced cancer and depression report a significantly higher symptom burden than non-depressed patients. Palliat Support Care 10:1–7.  https://doi.org/10.1017/S1478951517001183
  26. 26.
    Zweers D, de Graaf E, de Graeff A et al (2017) The predictive value of symptoms for anxiety in hospice inpatients with advanced cancer. Palliat Support Care 16(5):602–607CrossRefGoogle Scholar
  27. 27.
    Brown LF, Kroenke K, Theobald DE, Wu J, Tu W (2010) The association of depression and anxiety with health-related quality of life in cancer patients with depression and/or pain. Psychooncology 19:734–741CrossRefGoogle Scholar
  28. 28.
    Nipp RD, El-Jawahri A, Moran SM et al (2017) The relationship between physical and psychological symptoms and health care utilization in hospitalized patients with advanced cancer. Cancer 123:4720–4727CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Sebastiano Mercadante
    • 1
    • 2
  • Claudio Adile
    • 1
  • Patrizia Ferrera
    • 1
  • Andrea Cortegiani
    • 3
  • Alessandra Casuccio
    • 4
  1. 1.Main Regional Center for Pain Relief and Palliative/Supportive CarePalermoItaly
  2. 2.Department of Supportive Care & RehabilitationMD AndersonHoustonUSA
  3. 3.Department of Biopathology, Medical and Forensic Biotechnologies (DIBIMEF), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico “P, Giaccone”University of PalermoPalermoItaly
  4. 4.Department of Sciences for Health Promotion and Mother Child CareUniversity of PalermoPalermoItaly

Personalised recommendations