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

Nelson, Judith E. MD, JD; Meier, Diane E. MD; Oei, Erwin J. MD; Nierman, David M. MD; Senzel, Richard S. MRP; Manfredi, Paolo L. MD; Davis, Susan M. RN; Morrison, R. Sean MD

Clinical Investigations

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 of cancer who were consecutively admitted to a medical ICU during an 8-month period.

Setting Academic, university-affiliated, tertiary-care, urban medical center.

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 conditions 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 reports. Between 55% and 75% of ESAS responders reported experiencing pain, discomfort, anxiety, sleep disturbance, or unsatisfied hunger or thirst that they rated as moderate or severe, whereas depression and dyspnea at these levels were reported by approximately 40% and 33% of responders, respectively. Significant pain, discomfort, or both were associated with common ICU procedures, but most procedure-related symptoms were controlled adequately for a majority of patients. Inability to communicate, sleep disruption, and limitations on visiting were particularly stressful among ICU conditions studied.

Conclusions Among critically ill cancer patients, multiple distressing symptoms were common in the ICU, often at significant levels of severity. Symptom assessment may suggest more effective strategies for symptom control and may direct decisions about appropriate use of ICU therapies.

From the Division of Pulmonary and Critical Care Medicine, Departments of Medicine and Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, NY.

Drs. Nelson, Morrison, and Meier are Faculty Scholars of the Project on Death in America of the Open Society Institute. Dr. Meier is the recipient of a National Institute on Aging Academic Career Leadership Award (K07AG00903). Dr. Morrison is the recipient of a Mentored Clinical Scientist Development Award (K08AG00833-01) from the National Institute on Aging.

Address requests for reprints to: Judith E. Nelson, MD, JD, Medical Intensive Care Unit, Mount Sinai Medical Center, Box 1232, 1 Gustave Levy Place, New York, NY 10029.

Symptom assessment may suggest more effective strategies for symptom control and may direct decisions about appropriate use of intensive care unit therapies.

© 2001 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins