Symptoms tell it all: A systematic review of the value of symptom assessment to predict survival in advanced cancer patients

• Published in: Critical reviews in oncology/hematology Vol. 84; no. 1; pp. 130 - 148
• Main Authors: Trajkovic-Vidakovic, Marija, de Graeff, Alexander, Voest, Emile E, Teunissen, Saskia C.C.M
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 01-10-2012; Elsevier
• Subjects: Advanced cancer; Biological and medical sciences; Hematologic and hematopoietic diseases; Hematology, Oncology and Palliative Medicine; Humans; Medical sciences; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Neoplasm Staging; Neoplasms - diagnosis; Neoplasms - mortality; Palliative stage; Prognosis; Quality of life; Survival; Symptom Assessment; Symptoms; Tumors; Palliative stage; Advanced cancer; Prognosis; Survival; Symptoms; Quality of life; Human; Symptomatology; Cancerology; Malignant tumor; Bibliographic review; Cancer
• ISSN: 1040-8428; 1879-0461
• DOI: 10.1016/j.critrevonc.2012.02.011

Abstract Purpose To determine the prognostic meaning of symptoms in patients with advanced cancer. Design Medline, Embase, Cochrane and Cinahl databases were systematically explored. The predicting symptoms were also evaluated in the three stages of palliative care: disease-directed palliation, symptom-oriented palliation and palliation in the terminal stage. Results Out of 3167 papers, forty-four papers satisfied all criteria. Confusion, anorexia, fatigue, cachexia, weight loss, cognitive impairment, drowsiness, dyspnea, dysphagia, dry mouth and depressed mood were associated with survival in ≥50% of the studies evaluating these symptoms. Multivariate analysis showed confusion, anorexia, fatigue, cachexia, weight loss, dyspnea and dysphagia as independent prognostic factors in 30–56% of the studies. In the stage of disease-directed palliation anorexia, cachexia, weight loss, dysphagia and pain and in the stage of symptom-oriented palliation confusion, fatigue, cachexia, weight loss, dyspnea, dysphagia and nausea were shown to be independent predictors of survival in >30% of the studies. Conclusion Symptoms with independent predictive value are confusion, anorexia, fatigue, cachexia, weight loss, dyspnea and dysphagia. New insights are added by the variance between the three palliative stages.