JOURNAL OF PALLIATIVE MEDICINE Volume 17, Number 1, 2014 ª Mary Ann Liebert, Inc. DOI: 10.1089/jpm.2013.0422
Symptom Burden, Depression, and Suicidality in Chinese Elderly Patients Suffering from Advanced Cancer Hon Wai Benjamin Cheng, FHKCP, Kwok Ying Chan, FHKCP, Mau Kwong Michael Sham, FRCP, and Cho Wing Li, FHKCP Dear Editor: We write to describe the preliminary outcome of a study with the primary objective of assessing the symptom burden, depression, and suicidality of Chinese elderly patients suffering from advanced cancer. Despite serious concern over the suicidality of cancer patients in palliative care practice, few studies have addressed this issue. With the expected growth of the geriatric population in Hong Kong, more elderly advanced cancer patients were expected to be under palliative care. The study adopted a cross-sectional design and recruited a consecutive series of Chinese elderly aged 65 or above with advanced cancer who had been admitted to the palliative medical unit of the Grantham Hospital during the study period from March 1 to December 31, 2011. Patients recruited were in their palliative phase of disease, as defined by radiologically confirmed local-regional or distant metastasis. Recruited patients were asked to complete a battery of questionnaires. The Edmonton Symptom Assessment Scale (ESAS) has been adopted to measure symptom prevalence among the subjects.1 The Geriatric Depression Scale-short form (GDS-SF) was used to assess the depressive symptoms,2 while item 3 of the Hamilton Rating Scale for Depression (HRSD) was used to measure the extent of suicidality.3 A total of 52 elderly patients with advanced cancer were interviewed, with 11 patients being excluded because of poor physical condition, language barrier, and cognitive impairment. Forty-one eligible patients were recruited and all of them had completed the questionnaires. The mean score of the ESAS Symptom Distress Score (ESAS-SDS) was 36.9 (SD = 15.3). Among the individual items, fatigue was the most prevalent symptom and was present in 92.7% of subjects, with a mean score of 5.6 (SD = 2.8). The frequency of most symptoms and the overall symptom distress score were similar to previous studies using ESAS in symptom measurement in palliative cancer patients. Using GDS-SF score ‡ 8 as a screening cut-off point, significant depressive symptoms were common (43.9%) in this group of patients; this was remarkably higher than in previous local studies targeting a general geriatric population. Besides, up to 46.3% (n = 19) of patients reported the presence of suicidality, with 14.6% (n = 6) having had an active suicidal idea or having attempted suicide. A statistically significant positive correlation was found with suicidality and fatigue (r = 0.38, p < 0.05), depression (r = 0.61, p < 0.01), anxiety (r = 0.47, p < 0.01), well-being (r = 0.65, p < 0.01), and the ESAS-SDS (r = 0.71, p < 0.01). The GDS-SF
score also demonstrated strong positive correlation with suicidality (r = 0.79, p < 0.01). After multiple regression analysis on the suicidality measurement on item 3 of HRSD, the GDSSF score remained statistically significant and accounted for 61.7% of the total variance of suicidality. Elderly patients with advanced cancer had a significant symptom burden comparable to Western studies.4,5 Fatigue was the most prevalent symptom. When compared with previous local studies targeting general geriatric population, a much higher rate of depression and suicidal ideation was found in our study group. The depressive symptom was the most important independent factor for suicidality in this group of patients. The results of this study draw the attention of palliative care workers to the importance of mood and suicidality assessment in our daily care of advanced cancer elderly patients. References 1. Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K: The Edmonton Symptom Assessment System (ESAS): A simple method for the assessment of palliative care patients. J Palliat Care 1991;7:6–9. 2. Sheikh JI, Yesavage JA: Geriatric Depression Scale (GDS): Recent evidence and development of a shorter version. In: Brink TL (ed): Clinical Gerontology: A Guide to Assessment and Intervention. New York: Haworth Press, 1986, pp. 165–173. 3. Hamilton M: A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56–62. 4. Bruera E, Neumann C, Brenneis C, et al.: Frequency of symptom distress and poor prognostic indicators in palliative cancer patients admitted to a tertiary palliative care unit, hospices, and acute care hospitals. J Palliat Care 2000;16:16–21. 5. Jones JM, Cohen SR, Zimmermann C, Rodin G: Quality of life and symptom burden in cancer patients admitted to an acute palliative care unit. J Palliat Care 2010;26:94–102.
Address correspondence to: Hon Wai Benjamin Cheng, FHKCP Palliative Medical Unit Grantham Hospital 125 Wang Chuk Hang Road Aberdeen, Hong Kong E-mail: [email protected]
Grantham Hospital, Aberdeen, Hong Kong.