The course of symptom frequency and intensity in advanced cancer patients followed at home

Four hundred consecutive patients who were referred to a home palliative ca re program were prospectively surveyed to estimate the prevalence and sever ity of common symptoms according to the changes in the performance status. Patients were admitted for the presence of different symptoms and psychosoc ial support. Common symptoms included in a standard form were rated for sev erity (absent 0, mild I, moderate 2, severe 3)for each visit. Pain intensit y was rated on a numerical scale (0-10). For each level of Karnofsky perfor mance score (K), the frequency and the worse symptom intensity were recorde d until patient's death. Data from 370 patients were analyzed. Pain was eff ectively controlled In the final stage it was also less frequently observed , despite the use of lower analgesic doses in the last days of life. The pe ak of opioid consumption and symp,tom frequency and severity was found at K 40. This was also the most frequent K level at admission. Some symptoms, su ch as nausea and vomiting dry mouth, gastric pyrosis, and diarrhea reached a peak in frequency and severity, then decreased with the advanced stage of the disease. Other symptoms, such as dyspnea, drowsiness, weakness, and co nfusion tended to further increase and to have a peak at the lowest levels of K. Dysphagia and constipation progressively inn-Eased in frequency and i ntensity, but decreased at the end. These findings clarify the actual frequ ency and intensity of symptoms in a non-selected home care population with advanced cancer (C) U.S Cancer Pain Relief Committee, 2000.