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Palliative Medicine
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Symptom patterns of advanced cancer patients in a palliative care unit

Jaw-Shiun Tsai

Chih-Hsun Wu

Tai-Yuan Chiu

Department of Family Medicine, Hospice and Palliative Care Unit, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan

Wen-Yu Hu

School of Nursing Science, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan

Ching-Yu Chen

Department of Family Medicine, Hospice and Palliative Care Unit, College of Medicine and Hospital, National Taiwan University and Division of Gerontology Research, National Health Research Institutes, Taipei, Taiwan

This study involved longitudinal evaluations of symptom severity and describes the symptom patterns of 77 terminal cancer patients (median age: 62 years; 61% female), selected from 537 consecutive patients admitted to the Palliative Care Unit of the National Taiwan University Hospital. The most common primary cancer sites in these patients were lung (23.4%), liver (15.6%), and stomach (13%). Nineteen physical and psychological symptoms were assessed using different scales. The median number of symptoms was 11 (range: 1-18) on admission, among which weakness, fatigue, anorexia, pain, and depression were the most common. A comparison of the initial symptom severity scores with those at one week after admission and two days before death suggested six symptom change patterns: A: continuous static (restless/heat, abdominal fullness, constipation, dizziness, and insomnia); B: static-increase (fatigue, weakness, nausea/vomiting, taste alteration, dysphagia, diarrhea, dry mouth, and night sweats); C: decrease-static (pain and depression); D: decrease-increase (anorexia and dyspnea); E: static-decrease (aggression); and F: gradually decrease (anxiety). These six symptom patterns can be divided into two categories on the basis of the relative severity of symptoms between one week after admission and two days before death. The first category included patterns A, C, E and F, and the symptoms improved with palliative care. However, the symptoms in the second category (patterns B and D), which were associated with the anorexia-cachexia syndrome and dyspnea, did not show improvement. As symptom management is an essential component of palliative care, holistic care, which encompasses physical, psychosocial and spiritual aspects, represents a rational approach for the relief of these incurable symptoms at the end stage of life for these patients.

Key Words: advanced cancer • palliative care • symptom patterns

Palliative Medicine, Vol. 20, No. 6, 617-622 (2006)
DOI: 10.1177/0269216306071065
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