title: Symptoms tell it all: a systematic review of the value of symptom assessment to predict survival in advanced cancer patients.
abstract: OBJECTIVE
  To determine the prognostic meaning of symptoms in patients with advanced cancer.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medical Oncology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.
authors.forename: Marija
authors.initials: M
authors.lastname: Trajkovic-Vidakovic
authors.forename: Alexander
authors.initials: A
authors.lastname: de Graeff
authors.forename: Emile E
authors.initials: EE
authors.lastname: Voest
authors.forename: Saskia C C M
authors.initials: SC
authors.lastname: Teunissen
mesh_terms: D006801:Humans; D009367:Neoplasm Staging; D009369:Neoplasms / Q000175:diagnosis* / Q000401:mortality*; D011379:Prognosis; D063189:Symptom Assessment