title: The prevalence and burden of symptoms amongst cancer patients attending palliative care in two African countries.
abstract: BACKGROUND
  The majority of cancer presentations in Africa are advanced and incurable, with incidence of malignancies projected to increase significantly. Despite the African cancer burden, almost nothing is known about the symptomatology of malignant progressive disease. This study aimed to determine the symptom prevalence and burden amongst advanced cancer patients in two African countries.
  
  
  METHODS
  The Memorial Symptom Assessment Schedule Short Form (MSAS-SF) was used to measure the 7-d period prevalence and associated burden of multidimensional symptoms amongst adult patients attending palliative care in South Africa and Uganda. Further demographic and clinical variables were collected.
  
  
  RESULTS
  Of the 112 patients recruited, 22 (19.6%) had an underlying HIV diagnosis. The most common cancer primaries were breast (N=24), cervix (N=21) and lung (N=14). The mean number of symptoms was 18 (SD=6.6). The five most prevalent symptoms were pain (87.5%), lack of energy (77.7%), feeling sad (75.9%), feeling drowsy (72.3%) and worrying (69.6%). The five symptoms ranked as most severe were as follows: pain n=26 (23.2%), sexual problems n=24 (21.4%), weight loss n=21 (18.8%), 'I don't look like myself'n=21 (18.8%) and lack of energy n=20 (17.9%).
  
  
  CONCLUSIONS
  Pain and psychological problems were four of the five most common symptoms, found in more than 3 out of 4 patients. Our sample's reported mean number of symptoms was far higher than reported in other global studies. These data can inform the delivery of appropriate clinical care. The prevalence of multidimensional symptoms underlines the importance of holistic approaches to patient assessment and management, taking account of multiple and potentially interacting symptoms and locally appropriate intervention.
authors.affiliation: King's College London, Dept. Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, Bessemer Road, Denmark Hill, London SE5 9PJ, UK. richard.harding@kcl.ac.uk
authors.forename: Richard
authors.initials: R
authors.lastname: Harding
authors.forename: Lucy
authors.initials: L
authors.lastname: Selman
authors.forename: Godfrey
authors.initials: G
authors.lastname: Agupio
authors.forename: Natalya
authors.initials: N
authors.lastname: Dinat
authors.forename: Julia
authors.initials: J
authors.lastname: Downing
authors.forename: Liz
authors.initials: L
authors.lastname: Gwyther
authors.forename: Thandi
authors.initials: T
authors.lastname: Mashao
authors.forename: Keletso
authors.initials: K
authors.lastname: Mmoledi
authors.forename: Lydia Mpanga
authors.initials: LM
authors.lastname: Sebuyira
authors.forename: Barbara
authors.initials: B
authors.lastname: Ikin
authors.forename: Irene J
authors.initials: IJ
authors.lastname: Higginson
mesh_terms: D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000453:epidemiology* / Q000523:psychology; D010146:Pain / Q000209:etiology; D010166:Palliative Care / Q000706:statistics & numerical data*; D015995:Prevalence; D012423:Rural Health; D013019:South Africa / Q000453:epidemiology; D014454:Uganda / Q000453:epidemiology; D014504:Urban Health