Self-reported symptom experience of critically ill cancer patients receiving intensive care

Objective: To characterize the symptom experience of a cohort of intensive care unit (ICU) patients at high risk for hospital death. Design: Prospective analysis of patients with a present or past diagnosis o f cancer who were consecutively admitted to a medical ICU during an 8-month period. Setting: Academic, university-affiliated, tertiary-care, urban medical cent er. Patients: One hundred cancer patients treated in a medical ICU. Intervention: Assessment of symptoms. Measurements: Patients' self-reports of symptoms using the Edmonton Symptom Assessment Scale (ESAS), and ratings of pain or discomfort associated with ICU diagnostic/therapeutic procedures and of stress associated with condit ions in the ICU. Main Results: Hospital mortality for the group was 56%. Fifty patients had the capacity to respond to the ESAS, among whom 100% provided symptom repor ts. Between 55% and 75% of ESAS responders reported experiencing pain, disc omfort, anxiety, sleep disturbance, or unsatisfied hunger or thirst that th ey rated as moderate or severe, whereas depression and dyspnea at these lev els were reported by approximately 40% and 33% of responders, respectively. Significant pain, discomfort, or both were associated with common ICU proc edures, but most procedure-related symptoms were controlled adequately for a majority of patients. Inability to communicate, sleep disruption, and lim itations on visiting were particularly stressful among ICU conditions studi ed. Conclusions: Among critically ill cancer patients, multiple distressing sym ptoms were common in the ICU, often at significant levels of severity. Symp tom assessment may suggest more effective strategies for symptom control an d may direct decisions about appropriate use of ICU therapies.