title: Symptom distress and quality of life in patients with advanced chronic obstructive pulmonary disease.
abstract: Although chronic obstructive pulmonary disease (COPD) is a highly prevalent and disabling illness, few empirical studies have evaluated the impact of the disease on symptom distress, functional status, and quality of life. These outcomes were explored in a prospective survey of 100 patients with advanced COPD. Patients were recruited from two academic centers. The mean forced expiratory volume in 1 second (FEV1) was 24.4% (standard deviation=3.9). Validated instruments were used to assess symptom distress (Memorial Symptom Assessment Scale [MSAS]), mental health (Mental Health Inventory [MHI]-5), functional status (Sickness Impact Profile [SIP]), quality of life (Multidimensional Index of Life Quality [MILQ]), spirituality (Functional Assessment of Chronic Illness Therapy [FACIT] Spirituality Scale), and comorbid conditions (Charlson Comorbidity Index). The most prevalent symptoms were dyspnea (94%), fatigue (71%), xerostomia (60%), coughing (56%), and anxiety (51%). Other symptoms with high prevalence were drowsiness (47%), irritability (42%), feeling nervous (40%), and wheezing (40%). Significant pain was reported in about one-third of patients. Patients reported relatively high levels of overall functional impairment (SIP median=24.0) and modest impairment in overall quality of life (MILQ median=52). Overall, psychological well-being was relatively unimpaired (median=24.5), and the comfort derived from faith was intact (FACIT median=2.5). Impairment in quality of life was strongly associated with symptom distress (MSAS-GDI; r=-0.74, P<0.001), functional impairment (SIP total; r=-0.59, P<0.001), female sex (r=-0.26, P=0.01), and poor psychological well-being (MHI-5; r=0.68, P<0.001). In multivariate analyses, poor quality of life was strongly correlated with higher total symptom distress, sickness-related dysfunction, and lower levels of psychological well-being (R(2)=0.66). In addition, two specific psychological symptoms-worrying and feeling irritable-were independently predictive of poor quality of life. Patients with advanced COPD have multiple distressing symptoms and a high prevalence of disturbances in mood, functional status, and quality of life. A focus on ameliorating prevalent physical symptoms and psychological distress may lead to an improvement in the overall quality of life in this patient population.
authors.affiliation: Palliative Care Service, Massachusetts General Hospital and the Harvard Medical School Center for Palliative Care, Boston, Massachusetts, USA. cblinderman@partners.org
authors.forename: Craig D
authors.initials: CD
authors.lastname: Blinderman
authors.forename: Peter
authors.initials: P
authors.lastname: Homel
authors.forename: J Andrew
authors.initials: JA
authors.lastname: Billings
authors.forename: Sharon
authors.initials: S
authors.lastname: Tennstedt
authors.forename: Russell K
authors.initials: RK
authors.lastname: Portenoy
mesh_terms: D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D010146:Pain / Q000175:diagnosis / Q000453:epidemiology*; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000453:epidemiology*; D011788:Quality of Life; D018570:Risk Assessment; D012307:Risk Factors; D018434:Sickness Impact Profile; D013315:Stress, Psychological / Q000175:diagnosis / Q000453:epidemiology*