Physical symptoms appear to predict cancer prognosis

Physical symptoms that impact quality of life, such as nausea and shortness of breath, may predict shorter survival for patients with terminal cancer.

A new study published July 26, 2004 in the online edition of CANCER, a peer-reviewed journal of the American Cancer Society, finds a patient’s symptoms and results of quality of life assessments may provide important clues to an individual patient’s prognosis. Psychosocial factors, such as anxiety or spiritual distress, did not predict shorter survival.

In order to give the most appropriate treatment options to newly diagnosed cancer patients, physicians often assess a patient’s health-related quality of life (hrQoL), along with tumor characteristics that predict the aggressiveness of the disease and, ultimately, outcome (i.e., response rate to treatments, overall survival, time to progression, and survival in years). In the field of palliative care, length of survival and quality of life are paramount. Research has demonstrated that clinical factors and tumor characteristics predict survival in terminal cancer patients, but there is limited data on the predictive value of hrQoL measures, such as physical and psychological symptoms. Existing research suggests that physical symptoms, not psychosocial symptoms, predict length of survival. However, the conclusions of these studies are weakened by methodological shortfalls.

To overcome previous study design flaws, Dr. Antonio Vigano of the McGill University Health Center and his colleagues investigated the relationship between survival and multiple hrQoL variables among 1002 patients at the beginning of or at a later stage of terminal cancer (colorectal, breast, genitourinary, or lung cancer).

The authors found that physical hrQoL factors predicted shorter survival in both groups. The relationship was strongest in the later stage of terminal cancer. Among patients at the later stage, shortness of breath increased the risk of death by 50 percent for all cancer types studied, and weakness increased the risk of death for colorectal (three-fold), breast (five-fold) and genitourinary (four-fold) cancers. Among patients at the onset of the terminal stage of cancer, the risk of death increased 68 percent with nausea/vomiting and 28 percent with shortness of breath. However, other clinical and tumor characteristics more strongly predicted outcome in this group. No predictive value was observed for psychosocial factors, such as anxiety, spiritual distress and lack of insight.

The authors conclude, “our findings indicate that patients presenting with chronic nausea and vomiting, shortness of breath, and weakness are more advanced in the progress toward the terminal wasting associated with cancer than patients who do not present these symptoms” and “patients and families should be reassured that they do not feel they or their relatives are going to die sooner if they are in psychosocial distress.”