title: Voluntary reporting to assess symptom burden among Yemeni cancer patients: common symptoms are frequently missed.
abstract: BACKGROUND
  Adequate symptom assessment is necessary to relieve the high symptom burden experienced by cancer patients. However, health care professionals may depend only on patient's voluntary reporting (VR) to assess symptoms and therefore some symptoms may be missed.
  
  
  OBJECTIVE
  To assess the symptom burden experienced by Yemeni cancer patients by using VR and systematic assessment (SA).
  
  
  METHODS
  50 cancer patients were asked an open question to voluntarily report their symptoms. This was followed by an SA of a list of 20 common physical symptoms that was drawn up based on the literature.
  
  
  RESULTS
  From 375 symptom entries related to the 20 symptoms, VR accounted for 66 entries (18%) and SA for 309 (82%). The mean number of VR symptoms/patient was 1.3, and the mean number of VR plus SA symptoms was 7.5 (𝑃 < .001). In all, 74% of VR symptoms and 57% of SA symptoms were moderate or severe. For each symptom, the percentage of patients who experienced it and did not report it voluntarily (missed) was 100% for bleeding, constipation, early satiety, hoarseness, taste changes, and weight loss. These were followed by anorexia (97%), skin symptoms (92%), dry mouth (91%), edema (89%), dyspnea (88%), sore mouth (88%), fatigue/weakness (85%), diarrhea (80%), dysphagia (80%), nausea (76%), cough (75%), urinary symptoms (75%), vomiting (62%), and pain (18%). Pain was the most common voluntarily reported symptom (56% of patients), the most commonly distressing (42%), and the least under-reported (18%).
  
  
  CONCLUSIONS
  Relatively small sample size; the SA included only 20 symptoms.
  
  
  CONCLUSIONS
  SA of symptoms yields a more accurate estimation of symptom burden than does VR. As with many developing countries where the majority of cancer patients present at an incurable disease stage, Yemeni cancer patients suffer a high symptom burden, especially pain.
authors.affiliation: Palliative Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt. alsirafy@kasralainy.edu.eg.
authors.forename: Samy A
authors.initials: SA
authors.lastname: Alsirafy
authors.affiliation: National Oncology Center, Sana'a, Yemen.
authors.forename: Khalil A
authors.initials: KA
authors.lastname: Al-Alimi
authors.affiliation: National Oncology Center, Sana'a, Yemen.
authors.forename: Salem M
authors.initials: SM
authors.lastname: Thabet
authors.affiliation: National Oncology Center, Sana'a, Yemen.
authors.forename: Afif
authors.initials: A
authors.lastname: Al-Nabhi
authors.affiliation: National Oncology Center, Sana'a, Yemen.
authors.forename: Nahla A
authors.initials: NA
authors.lastname: Aklan
keywords: Yemen; cancer; pain; palliative care; symptoms; systematic assessment; voluntary reporting