Annals of Surgical Oncology

, Volume 17, Issue 2, pp 461–469 | Cite as

Malignant Ascites Symptom Cluster in Patients Referred for Paracentesis

  • Amna Husain
  • Andrea Bezjak
  • Alexandra Easson
Gastrointestinal Oncology



Malignant ascites (MA) is a distressing problem usually managed by repeated paracenteses. Paracentesis represents a meaningful time point in identifying patients with a specific presentation.


The objective of this study is to examine symptom clustering in MA patients at paracentesis.


Pre- and post-paracentesis, patients completed the Edmonton Symptom Assessment Scale revised to include abdominal distension and mobility (ESAS:AM) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). This is a secondary analysis of data previously published, which reported on the validity of these surveys in MA. The symptoms were clustered using a hierarchical cluster analysis technique.


In 37 cancer patients with complete data, there were two clusters common at both pre- and post-paracentesis time points: (1) depression–anxiety; (2) fatigue–appetite–wellbeing–mobility. Paracentesis resulted in an improvement in ESAS/AM total score (SDS/AM), abdominal distension, and shortness of breath (P < 0.001, threshold adjusted for multiple comparisons). On the EORTC QLQ-C30, the domains of role functioning and global quality of life (QOL) showed a trend towards improvement, while the domains of cognitive and emotional QOL declined significantly (P < 0.001, threshold adjusted for multiple comparisons), despite improvement in individual symptoms commonly attributed to ascites.


This study is the first to describe symptom clusters in MA. Studies in MA should include measurement of the more global symptoms of fatigue, wellbeing, depression, and anxiety in addition to shortness of breath, abdominal distension, and mobility. Patients presenting with MA require a comprehensive assessment and a management plan that addresses QOL and the emotional domain symptoms shown to cluster in these patients.


Fatigue Abdominal Distension Symptom Cluster Malignant Ascites Edmonton Symptom Assessment System 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We are grateful for the contribution of Dr. Alice Newman, Fariba Sam, Barbara Thomson, Jennifer Jones, Jacqueline Leung, Erica Moran, and Christopher Obwanga. The study was supported by a grant from Physician Services Incorporated Fund, the Rose and Arthur Brooks Memorial Fund, and the Frankfort Fund.


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Copyright information

© Society of Surgical Oncology 2009

Authors and Affiliations

  1. 1.Temmy Latner Centre for Palliative Care, Mount Sinai HospitalUniversity of TorontoTorontoCanada
  2. 2.Department of Radiation Oncology, Princess Margaret HospitalUniversity of TorontoTorontoCanada
  3. 3.Department of Surgical Oncology, Princess Margaret Hospital, Mount Sinai HospitalUniversity of TorontoTorontoCanada

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