The Relation between the Severity of Pain and Common Symptoms in Patients with Metastatic Cancer

Document Type : Original Article

Authors

1 Clinical Oncology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt

2 Palliative Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt

Abstract

Background: There is a relation between the severity of pain and common symptoms in patients with metastatic cancer.
Aim: This study was done to explore this relation among Egyptian patients with advanced cancer.
Methods: The study included 120 adult metastatic cancer patients with pain from two cancer centers in Cairo and Sharkia,
Egypt. Pain and other common symptoms were assessed using the Arabic version of the Edmonton Symptom Assessment
System (ESAS). The Eastern Cooperative Oncology Group (ECOG) performance scale was used to assess performance
status.
Results: The prevalence of ESAS symptoms was high among patients with cancer pain (tiredness, 94%; drowsiness, 63%;
nausea, 60%; lack of appetite, 77%; shortness of breath, 53%; depression, 88%; anxiety, 83%; poor wellbeing, 96%). The
ECOG performance scale was 1 in 21 (17.5%) patients, 2 in 57 (47.5%), 3 in 38 (31.7%) and 4 in 4 (3.3%). The average
ESAS score was 33.9 ± 13.8, 48.9 ± 14.7, 58 ± 15.4 and 70 ± 5.5 among patients with ECOG score 1, 2, 3 and 4;
respectively (p < 0.001). There was no significant difference in the average score of any of the ESAS items according to
the site of metastases. There was a significant positive correlation between the pain score and the scores of tiredness
(p < 0.001), nausea (p=0.037), lack of appetite (p < 0.001), shortness of breath (p=0.001), depression (p < 0.001), anxiety
(p < 0.001) and poor wellbeing (p < 0.001).
Conclusion: Egyptian patients with cancer pain experience high symptom burden. The severity of pain strongly correlates
with the presence and severity of other ESAS symptoms. Systematic assessment of other symptoms is indispensable in
patients with cancer pain for proper control of symptoms and improving quality of life.

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