Support Care Cancer DOI 10.1007/s00520-014-2149-8
ORIGINAL ARTICLE
Quality of life and symptoms in patients with malignant diseases admitted to a comprehensive cancer centre Annette Sand Strömgren & Carsten Utoft Niemann & Ulla Brix Tange & Hanne Farholt & Nan M. Sonne & Lena Ankersen & Lisbet Kristensen & Lisbeth Bendixen & Mogens Groenvold & Morten Aagaard Petersen & Mie Nordly & Lona Christrup & Per Sjøgren & Geana Paula Kurita
Received: 23 April 2013 / Accepted: 28 January 2014 # Springer-Verlag Berlin Heidelberg 2014
Abstract Purpose Quality of life and symptomatology in patients with malignancies admitted to comprehensive cancer centres are rarely investigated. Thus, this study aimed to investigate symptomatology and health-related quality of life of inpatients with cancer. Methods A prospective, cross-sectional study was carried out on two occasions 5 weeks apart in haematology and oncology departments at a comprehensive cancer centre. Assessment A. S. Strömgren (*) : U. B. Tange : L. Ankersen : L. Kristensen : M. Nordly Department of Oncology, 5073 Finsen Centre, Rigshospitalet Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark e-mail: [email protected] C. U. Niemann Department of Haematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark H. Farholt : N. M. Sonne : L. Bendixen : P. Sjøgren : G. P. Kurita Section of Palliative Medicine, Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark M. Groenvold : M. A. Petersen
included demographic data, WHO performance status (PS), EORTC QLQ-C30 and pain scales of brief pain inventory. Comparisons were analysed using Wilcoxon two-sample test, rank tests and Fisher’s exact test. Results One hundred twenty-four patients were analysed, mean age=59 years (SD=13.7), 42 % admitted to haematological department; lung cancer was the most frequent diagnosis (15 %). Low health-related quality of life and severe symptom burden, especially fatigue and appetite loss, were observed among the inpatients. In addition, role and social functions appeared to be more impaired in haematology patients than in those admitted to oncology (P=0.0372 and 0.0167, respectively). On the other hand, pain and constipation were more severely affected in oncology patients (P= 0.0194 and 0.0064, respectively). Conclusions Patients in the wards of haematology and oncology had pronounced symptomatology and low quality of life. A more systematic focus on the amelioration of problems with functioning and symptoms among inpatients with malignant diseases is warranted. Keywords Signs and symptoms . Quality of life . Cancer . Haematology . Palliative care
Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark L. Christrup Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences University of Copenhagen, Copenhagen, Denmark M. Nordly : P. Sjøgren Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark G. P. Kurita Multidisciplinary Pain Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
Introduction Whereas symptom assessment and symptom management are cornerstones in palliative medicine, there has been less focus on these issues in patients treated in oncology or haematology. Health-related quality of life (HRQoL) is a frequently utilised outcome measure in clinical trials in cancer patients [1]. For patients with advanced disease, where cure is not a realistic treatment goal, the importance of HRQoL may become the outcome of interest in deciding between different choices of
Support Care Cancer
treatment [2]. However, during daily clinical practice for haematology and oncology inpatients with a broad variety of diseases, disease stages and treatment goals, HRQoL is rarely addressed in a systematic way [3, 4]. Current literature suggests that contact with specialist palliative care for patients diagnosed with haematological malignancy is infrequent [5], and a randomised study in lung cancer patients showed that randomisation to early palliative care might even prolong survival [6], but cross-sectional data on symptom assessment on inpatients is scarce. Because such symptom burden appears to be present at all phases of the illness, comprehensive symptom assessment is suggested throughout the entire disease trajectory. The availability of specialist palliative care services may assist carers in the management of their patients’ symptoms and ameliorate HRQoL [5, 6]. In the comprehensive cancer centre of Copenhagen University Hospital, a multidisciplinary palliative team was recently established. To further integrate specialised supportive and palliative care in the daily treatment of patients in oncology and haematology, we wanted to explore the HRQoL, functional capacity and symptomatology among inpatients with malignancies at the Departments of Haematology and Oncology at Rigshospitalet, Copenhagen University Hospital. Thus, the aim of this prospective, cross-sectional survey was to study disease-related and treatment-related HRQoL, functional capacity and symptomatology in a representative sample of inpatients at our comprehensive cancer centre.
Methods Design A prospective, cross-sectional study was carried out on two occasions 5 weeks apart in May and June 2011 in each of the three wards of haematology and five of oncology at Rigshospitalet, Copenhagen University Hospital, Denmark. For logistic reasons, the survey was performed at different dates for each of the included wards. Patients Patients were included if they were ≥18 years, hospitalised at one of the departments due to malignant disease at the days of the study, able to understand the questionnaires, fluent in the Danish language, present in the wards at the time of assessment and able and willing to give informed consent to participate in the study. Patients could only participate once. Assessments The survey was based upon demographic and treatment data obtained from the patients’ case notes (gender, age, type of
malignant disease and treatment intention (curative/adjuvant versus palliative)). WHO performance status (WHO PS) [7] was directly assessed by the investigators during interview. HRQoL was assessed by the Danish version of the EORTC QLQ-C30 (version 3.0) quality of life instrument [8], and pain conditions were further explored by the five-pain rating scales of the Danish version of the validated Norwegian brief pain inventory (BPI) [9, 10]. Norwegian is very similar to the Danish language, and direct translation involved only slightly different spelling. The WHO PS consists in a five-grade scale from 0 to 4, in which score 0 means “able to carry out all normal activity without restriction” and 4 means “completely disabled; cannot carry on any self-care; totally confined to bed or chair” [7]. The EORTC QLQ-C30 is designed to cover several aspects of the patient’s health-related quality of life (physical as well as psychosocial aspects). The questions in EORTC QLQ-C30 are transformed into five function scales (physical, role, cognitive, emotional and social), three symptom scales (fatigue, pain and nausea/vomiting), six single items and additional symptoms (dyspnoea, loss of appetite, insomnia, constipation, diarrhoea and financial difficulties) and a global health status scale. Following the scoring manual, responses were converted to 0–100 scales. For single items, “0” corresponds to “not at all” (symptom), “33.3” to “a little”, “66.7” to “quite a bit” and “100” to “very much”. In the function scales, a high score reflects a good functioning, whereas a high score on a symptom scale reflects a high level of the symptom [11]. For the EORTC QLQ-C30, there is no defined cutoff indicating if a given patient’s score on a function or symptom should be interpreted e.g. as a “symptom” or a “severe symptom”. We chose the cutoff points >34 and >67 as thresholds of “symptom” and “severe symptom”, respectively, for the symptom scales, corresponding to more than “a little” (33.3) and more than “quite a bit” (66.7). For the function scales, the thresholds for impairment were
ORIGINAL ARTICLE
Quality of life and symptoms in patients with malignant diseases admitted to a comprehensive cancer centre Annette Sand Strömgren & Carsten Utoft Niemann & Ulla Brix Tange & Hanne Farholt & Nan M. Sonne & Lena Ankersen & Lisbet Kristensen & Lisbeth Bendixen & Mogens Groenvold & Morten Aagaard Petersen & Mie Nordly & Lona Christrup & Per Sjøgren & Geana Paula Kurita
Received: 23 April 2013 / Accepted: 28 January 2014 # Springer-Verlag Berlin Heidelberg 2014
Abstract Purpose Quality of life and symptomatology in patients with malignancies admitted to comprehensive cancer centres are rarely investigated. Thus, this study aimed to investigate symptomatology and health-related quality of life of inpatients with cancer. Methods A prospective, cross-sectional study was carried out on two occasions 5 weeks apart in haematology and oncology departments at a comprehensive cancer centre. Assessment A. S. Strömgren (*) : U. B. Tange : L. Ankersen : L. Kristensen : M. Nordly Department of Oncology, 5073 Finsen Centre, Rigshospitalet Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark e-mail: [email protected] C. U. Niemann Department of Haematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark H. Farholt : N. M. Sonne : L. Bendixen : P. Sjøgren : G. P. Kurita Section of Palliative Medicine, Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark M. Groenvold : M. A. Petersen
included demographic data, WHO performance status (PS), EORTC QLQ-C30 and pain scales of brief pain inventory. Comparisons were analysed using Wilcoxon two-sample test, rank tests and Fisher’s exact test. Results One hundred twenty-four patients were analysed, mean age=59 years (SD=13.7), 42 % admitted to haematological department; lung cancer was the most frequent diagnosis (15 %). Low health-related quality of life and severe symptom burden, especially fatigue and appetite loss, were observed among the inpatients. In addition, role and social functions appeared to be more impaired in haematology patients than in those admitted to oncology (P=0.0372 and 0.0167, respectively). On the other hand, pain and constipation were more severely affected in oncology patients (P= 0.0194 and 0.0064, respectively). Conclusions Patients in the wards of haematology and oncology had pronounced symptomatology and low quality of life. A more systematic focus on the amelioration of problems with functioning and symptoms among inpatients with malignant diseases is warranted. Keywords Signs and symptoms . Quality of life . Cancer . Haematology . Palliative care
Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark L. Christrup Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences University of Copenhagen, Copenhagen, Denmark M. Nordly : P. Sjøgren Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark G. P. Kurita Multidisciplinary Pain Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
Introduction Whereas symptom assessment and symptom management are cornerstones in palliative medicine, there has been less focus on these issues in patients treated in oncology or haematology. Health-related quality of life (HRQoL) is a frequently utilised outcome measure in clinical trials in cancer patients [1]. For patients with advanced disease, where cure is not a realistic treatment goal, the importance of HRQoL may become the outcome of interest in deciding between different choices of
Support Care Cancer
treatment [2]. However, during daily clinical practice for haematology and oncology inpatients with a broad variety of diseases, disease stages and treatment goals, HRQoL is rarely addressed in a systematic way [3, 4]. Current literature suggests that contact with specialist palliative care for patients diagnosed with haematological malignancy is infrequent [5], and a randomised study in lung cancer patients showed that randomisation to early palliative care might even prolong survival [6], but cross-sectional data on symptom assessment on inpatients is scarce. Because such symptom burden appears to be present at all phases of the illness, comprehensive symptom assessment is suggested throughout the entire disease trajectory. The availability of specialist palliative care services may assist carers in the management of their patients’ symptoms and ameliorate HRQoL [5, 6]. In the comprehensive cancer centre of Copenhagen University Hospital, a multidisciplinary palliative team was recently established. To further integrate specialised supportive and palliative care in the daily treatment of patients in oncology and haematology, we wanted to explore the HRQoL, functional capacity and symptomatology among inpatients with malignancies at the Departments of Haematology and Oncology at Rigshospitalet, Copenhagen University Hospital. Thus, the aim of this prospective, cross-sectional survey was to study disease-related and treatment-related HRQoL, functional capacity and symptomatology in a representative sample of inpatients at our comprehensive cancer centre.
Methods Design A prospective, cross-sectional study was carried out on two occasions 5 weeks apart in May and June 2011 in each of the three wards of haematology and five of oncology at Rigshospitalet, Copenhagen University Hospital, Denmark. For logistic reasons, the survey was performed at different dates for each of the included wards. Patients Patients were included if they were ≥18 years, hospitalised at one of the departments due to malignant disease at the days of the study, able to understand the questionnaires, fluent in the Danish language, present in the wards at the time of assessment and able and willing to give informed consent to participate in the study. Patients could only participate once. Assessments The survey was based upon demographic and treatment data obtained from the patients’ case notes (gender, age, type of
malignant disease and treatment intention (curative/adjuvant versus palliative)). WHO performance status (WHO PS) [7] was directly assessed by the investigators during interview. HRQoL was assessed by the Danish version of the EORTC QLQ-C30 (version 3.0) quality of life instrument [8], and pain conditions were further explored by the five-pain rating scales of the Danish version of the validated Norwegian brief pain inventory (BPI) [9, 10]. Norwegian is very similar to the Danish language, and direct translation involved only slightly different spelling. The WHO PS consists in a five-grade scale from 0 to 4, in which score 0 means “able to carry out all normal activity without restriction” and 4 means “completely disabled; cannot carry on any self-care; totally confined to bed or chair” [7]. The EORTC QLQ-C30 is designed to cover several aspects of the patient’s health-related quality of life (physical as well as psychosocial aspects). The questions in EORTC QLQ-C30 are transformed into five function scales (physical, role, cognitive, emotional and social), three symptom scales (fatigue, pain and nausea/vomiting), six single items and additional symptoms (dyspnoea, loss of appetite, insomnia, constipation, diarrhoea and financial difficulties) and a global health status scale. Following the scoring manual, responses were converted to 0–100 scales. For single items, “0” corresponds to “not at all” (symptom), “33.3” to “a little”, “66.7” to “quite a bit” and “100” to “very much”. In the function scales, a high score reflects a good functioning, whereas a high score on a symptom scale reflects a high level of the symptom [11]. For the EORTC QLQ-C30, there is no defined cutoff indicating if a given patient’s score on a function or symptom should be interpreted e.g. as a “symptom” or a “severe symptom”. We chose the cutoff points >34 and >67 as thresholds of “symptom” and “severe symptom”, respectively, for the symptom scales, corresponding to more than “a little” (33.3) and more than “quite a bit” (66.7). For the function scales, the thresholds for impairment were
