Physical symptoms common, disabling among patients with cancer and pain or depression

October 11, 2010

Patients with cancer who experience pain or depression also have a high rate of physical symptoms, such as fatigue, dry mouth and nausea, according to a report in the October 11 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

Having many physical, or somatic, symptoms is known to adversely affect patients in primary care settings and those with chronic medical conditions other than cancer, according to background information in the article. "Somatic symptoms account for more than half of all general medical visits, lack a definitive medical explanation one-third to half of the time and are frequently persistent," the authors write. "Physical and psychological factors seem to contribute to somatic symptom reporting, even in patients with chronic medical disorders. These symptoms are associated with substantial functional impairment, disability and health care use, even after controlling for medical and psychiatric comorbidity."

Kurt Kroenke, M.D., of the Richard Roudebush VA Medical Center, Indiana University, and Regenstrief Institute Inc., Indianapolis, and colleagues analyzed data from 405 patients with cancer who also had either pain or depression. Participants reported the presence and burden of 22 different somatic symptoms, along with the number of days of disability within the previous three-month period and health care use.

All patients in the study had at least one somatic symptom. More than half of the patients reported 15 of the 22 symptoms. The most common symptoms were feeling tired (97.5 percent), having difficulty sleeping (78.8 percent), pain in the limbs or joints (78 percent), back pain (74.8 percent) and difficulty remembering things (72.1 percent).

Participants reported an average of 16.9 disability days in the previous four weeks, including 5.7 days in bed and 11.2 days when they reduced their activities by 50 percent or more. Health care usage was high: 32 percent of patients reported three to five outpatient visits in the previous three months, 28 percent reported six to 10 visits and 26 percent reported more than 10 visits. More than one-third (38 percent) were hospitalized at least once and one-third visited the emergency department one or more times.

On a scale of zero to 44, with 44 being the worst, participants had an average somatic symptom burden score of 18.3. A higher score was associated with education, employment status, income and an emergency department or mental health visit in the previous three months but not with sex, race or marital status. For every five-unit increase in somatic symptom burden score, the probability of having at least 14 days of disability in the previous 28 days increased by 50 percent.

"This study strengthens the case for improving the recognition and treatment of somatic symptoms in patients with cancer," the authors conclude. "Given the strong association with disability and the high prevalence of many types of symptoms, recognizing and managing somatic symptoms may be important in improving quality of life and functional status regardless of type or phase of cancer."
-end-
(Arch Intern Med. 2010;170[18]:1686-1694. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: This study was supported by a grant from the National Cancer Institute. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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