Intensity and treatment of symptoms in 3,030 palliative care patients: A cross-sectional survey of the EAPC Research Network

Eivor Alette Laugsand, PhD-student; Stein Kaasa, MD; Franco de Conno, MD; Geoffrey Hanks, MD; Pål Klepstad, MD

doi:10.5055/jom.2009.0002

Authors

Eivor Alette Laugsand, PhD-student
Stein Kaasa, MD
Franco de Conno, MD
Geoffrey Hanks, MD
Pål Klepstad, MD

DOI:

https://doi.org/10.5055/jom.2009.0002

Keywords:

cancer, palliative care, opioid, adverse effects, signs and symptoms

Abstract

Objective: This study aimed to describe intensity and treatment of symptoms other than pain in European palliative care units.
Patients: A total of 3,030 patients, including 2,064 that used an opioid, were included from 143 palliative care centers, in 21 European countries.
Results: Pain was treated with analgesics corresponding to the WHO pain ladder step I (n = 374), II (n = 497), and III (n = 1,567). Frequencies of symptoms observed as moderate or severe were for generalized weakness (50 percent), fatigue (48 percent), anxiety (28 percent), anorexia (26 percent), constipation (18 percent), focal weakness (18 percent), depression (18 percent), and dyspnoea (15 percent). When comparing WHO-groups, cancer diagnoses, metastasis sites, countries, and genders, we found that some of the symptom intensities and treatments differed significantly between subgroups. A majority of patients used drugs for symptom management. Still, more than one-third of patients assessed to have moderate or severe constipation did not receive any treatment. The corresponding numbers for depression, confusion, nausea, vomiting, or anxiety were approaching 40 percent and for poor sleep about 50 percent. Prescription practice of antiemetics, laxatives, and psychotropic drugs varied widely between countries both in terms of preparation and percent of patients receiving a specific treatment.
Conclusions: This survey shows that clinically relevant symptoms are frequent and that one-third to half of the patients with a symptom observed as moderate or severe do not receive any treatment aimed to reduce the symptom intensity. Several symptoms and treatments differed between WHO-groups, cancer diagnoses, metastasis locations, countries, and genders. Prescription practice varied between countries both in terms of medication administered and percent of patients receiving specific treatment.

Author Biographies

Eivor Alette Laugsand, PhD-student

Research Fellow, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.

Stein Kaasa, MD

Professor, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Oncology, St. Olav’s University Hospital, Trondheim, Norway.

Franco de Conno, MD

Professor, Rehabilitation and Palliative Care, Istituto Nazionale Dei Tumori, Milano, Italy.

Geoffrey Hanks, MD

Professor, Department of Palliative Medicine, Bristol Haematology and Oncology Centre, Bristol, United Kingdom.

Pål Klepstad, MD

Professor, Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway;
Department of Anaesthesiology and Emergency Medicine, St. Olav’s University Hospital, Trondheim, Norway.

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