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



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.


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).


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.


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


Advanced cancer Anxiety Depression Palliative care 


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.


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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

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