UICC World Cancer Congress 2006

Objective: Advanced cancer is associated with median of 13 symptoms per patient.Symptoms are usually chronic, moderate to severe, influenced by age, gender. Certain symptoms anorexia, dyspnea, are prognostic. Symptoms occur in clusters, non-random associations. We report symptom clusters, pain in advanced lung cancer from 1,000 patient dataset, 235 had lung cancer

Methods: 235 lung cancer patients completed a 38-symptom checklist at initial consultation. A cluster analysis was performed on 25 symptoms with >15% prevalence. An agglomerative hierarchical method was used, linkage was selected, using the absolute value of the correlation between symptoms measuring similarity. A correlation > 0.70 defined clusters. Pain was none, mild, moderate, severe.

Results:Seven symptom clusters were found. 1) Anorexia Cachexia (anorexia, early satiety) (R=0.94); 2) Upper GI (bloating and belching) (R=0.91); 3) Aerodigestive (hoarseness and dysphagia) (R=0.89); 4) Debility cluster (easy fatigue, lack of energy, weakness, xerostomia) (R=0.83); 5) Pulmonary (cough and dyspnea) (R=0.80); 6) Dizziness/Dyspepsia cluster (R=0.77); 7) Neuropsychiatric (depression, anxiety, insomnia) (R=0.73). Nausea, vomiting (nausea, vomiting, taste changes) were just below correlation cutoff (R=0.69). Pain did not cluster with anxiety, depression nor fatigue, depression. Pain was associated with constipation (R=0.66). A close association but not cluster occurred between anorexia, weight loss (R=0.62), bloating, belching, dizziness, dyspepsia (0.62). Pain was severe in 82 (35%), moderate in 65 (28%), mild in 36 (15%). Moderate to severe pain occurred in 63%. Seven clusters were identified in patients referred to palliative medicine.

Seven symptom clusters occur in lung cancer. 2/3 of individuals with lung cancer will have moderate to severe pain.