title: Symptom severity of patients with advanced cancer in palliative care unit: longitudinal assessments of symptoms improvement.
abstract: BACKGROUND
  This study assessed the symptom severity of patients with advanced cancer in a palliative care unit and explored the factors associated with symptom improvement.
  
  
  METHODS
  This study was conducted in a palliative care unit in Taiwan between October 2004 and December 2009. Symptom intensity was measured by the "Symptom Reporting Form", and graded on a scale of 0 to 4 (0 = none, and 4 = extreme). These measures were assessed on the 1(st), 3(rd), 5(th), and 7(th) Day in the palliative care unit. The study data comprised routine clinical records and patients' demographic data. Generalized estimating equation (GEE) was used to assess the symptom improvement, and investigate the factors associated with the symptom reporting form scores.
  
  
  RESULTS
  Among the 824 recruited patients with advanced cancer, pain (78.4%), anorexia (64.4%) and constipation (63.5%) were the most common and severe symptom. After controlling for other factors in the multivariate GEE model, the day of palliative care administration was a significant factor associated with all of the scales, except Days 7 on the dyspnoea and oedema scales and Day 5 on the anxiety scale. In addition, patients aged ≥ 65 years exhibited significantly lower scores on the pain, sleep disturbance, depression, and anxiety scales than did those aged < 65 years. Moreover, female patients exhibited higher scores on the vomiting, anorexia, oedema, depression, and anxiety scales than did male patients. Furthermore, patients with gastrointestinal tract cancer exhibited higher scores on the constipation, vomiting, anorexia, oedema, depression, and anxiety scales and lower scores on the dyspnoea scale than did those with lung cancer. Patients with breast cancer exhibited higher scores on the oedema scale and lower scores on the anxiety scale. Patients with genitourinary cancer exhibited higher scores on the vomiting and oedema scales and lower scores on the dyspnoea scale. Patients with head, neck, and oral cancer exhibited lower scores on the oedema scale alone.
  
  
  CONCLUSIONS
  The symptom severity declined during the first week in the palliative care unit. In addition, differences in sex and primary cancer sites may contribute to varying degrees of symptom improvement.
authors.affiliation: Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.|Department of Family Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.|Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.|Department of Family Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Shu-Yu
authors.initials: SY
authors.lastname: Tai
authors.affiliation: Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Chung-Yin
authors.initials: CY
authors.lastname: Lee
authors.affiliation: Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Chien-Yi
authors.initials: CY
authors.lastname: Wu
authors.affiliation: Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Hui-Ya
authors.initials: HY
authors.lastname: Hsieh
authors.affiliation: Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Joh-Jong
authors.initials: JJ
authors.lastname: Huang
authors.affiliation: Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. chtshu@kmu.edu.tw.
authors.forename: Chia-Tsuan
authors.initials: CT
authors.lastname: Huang
authors.affiliation: Department of Otorhinolaryngology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. chenyu@cc.kmu.edu.tw.|Departments of Otorhinolaryngology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. chenyu@cc.kmu.edu.tw.|Department of Otolaryngology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. chenyu@cc.kmu.edu.tw.
authors.forename: Chen-Yu
authors.initials: CY
authors.lastname: Chien
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000855:Anorexia / Q000175:diagnosis; D001007:Anxiety / Q000175:diagnosis; D003248:Constipation / Q000175:diagnosis; D003863:Depression / Q000175:diagnosis; D004417:Dyspnea / Q000175:diagnosis; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D010146:Pain / Q000175:diagnosis; D010166:Palliative Care; D012720:Severity of Illness Index; D063189:Symptom Assessment / Q000592:standards*; D013624:Taiwan
keywords: Advanced cancer; Generalised estimating equation; Palliative care; Symptom severity