Financial distress and its impact on symptom expression in advanced cancer patients

65 Background: Cancer patients who smoke have been reported to have higher pain expression and increased risk for opioid abuse. The purpose of our study is to evaluate the association between tobacco use, symptom expression, and maladaptive coping in advanced cancer patients. Methods: We prospectively enrolled advanced cancer patients evaluated in an outpatient Supportive Care Center and collected data on patient demographics, cancer diagnosis, morphine equivalent daily dose (MEDD), cigarette smoking status using Behavioral Risk Factor Surveillance System, symptom expression as measured by Edmonton Symptom Assessment Scale, Cut down/Annoyed/Guilty/Eye opener (CAGE alcoholism questionnaire), short form Screener and Opioid Assessment for Patients with Pain (SOAP-SF) survey, and Brief COPE Questionnaire. Results: Among399 patients, 195 (49%) were never smokers, 158 (40%) former smokers, and 46 (11%) current smokers. The most common malignancies were gastrointestinal (21.1%) and breast (19.5%). Never smokers were more likely to be female (p = 0.005). Current smokers expressed significantly higher pain scores at consultation than former or never smokers [median 7 vs. 6 vs. 5, respectively (p = 0.015)], increased MEDD (median 90 vs. 60 vs. 50, p = 0.002), and more likely to screen CAGE positive (33% vs. 24% vs. 8.7%, p < 0.0001). Compared with former and never smokers, current smokers were significantly more likely to cope with substance use (p = 0.02), denial (p = 0.007), and self-blame (< 0.0001), while both current and former smokers significantly more likely to use venting (p = 0.04). In addition, current smokers compared with former and never smokers were significantly more likely screen positive (≥ 4) on the SOAP-SF survey (74% vs. 13% vs. 9.3%, p = < 0.0001) and clinicians rated patients to be at higher risk for maladaptive coping (6.5% vs 2.5% vs. 1.5%, p = 0.003). Conclusions: In advanced cancer, current and former smokers were significantly more likely to have higher pain expression, CAGE positivity, and increased MEDD at consultation. In addition, a history of current or past tobacco use in advanced cancer patients was associated with increased risk of maladaptive coping.

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Association between alcoholism and symptom expression, patient symptom goals, and clinical response in advanced cancer patients

Supportive Care in Cancer ◽

10.1007/s00520-019-05152-x ◽

2019 ◽

Vol 28 (7) ◽

pp. 3361-3369

Author(s):

Sebastiano Mercadante ◽

Claudio Adile ◽

Patrizia Ferrera ◽

Alessandra Casuccio

Keyword(s):

Clinical Response ◽

Cancer Patients ◽

Advanced Cancer ◽

Symptom Expression ◽

Advanced Cancer Patients ◽

Patient Symptom

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The Role of Religiosity in Symptom Expression of Advanced Cancer Patients

American Journal of Hospice and Palliative Medicine® ◽

10.1177/10499091211041349 ◽

2021 ◽

pp. 104990912110413

Author(s):

Sebastiano Mercadante ◽

Claudio Adile ◽

Marianna Ricci ◽

Marco Maltoni ◽

Giuseppe Bonanno ◽

...

Keyword(s):

Cancer Patients ◽

Advanced Cancer ◽

Social Relationship ◽

Karnofsky Performance Status ◽

Depression Scale ◽

Symptom Expression ◽

Advanced Cancer Patients ◽

Edmonton Symptom Assessment Scale ◽

Relevant Role

Aim: The aim of this study was to assess the religious pattern and its impact on symptom expression in patients with advanced cancer. Methods: A consecutive sample of advanced cancer patients screened at admission to palliative care. Standard epidemiological data were recorded. Patients were asked about their religious beliefs, the degree of social relationship to existing religions, the role of religion in their life, and the frequency of their prayer. The Edmonton Symptom Assessment Scale (ESAS) and Hospital Anxiety Depression scale (HADS) were assessed. Results: Two-hundred-eighty-three patients were screened. Age and gender were found to be independently correlated with religious belief (p = 0.042 and p = 0.016, respectively). Gender (females, p = 0.026), age (p = 0.003), lower Karnofsky performance status (KPS) (p = 0.022), and higher values of HADS-A (p = 0.003) were independently correlated with the degree of social relationship to existing religions. Gender (females, p = 0.002), lower KPS (p = 0.005), and higher values of HADS-A (p = 0.04) were independently correlated with a more relevant role of religiosity. Gender (females, p < 0.0005), lower KPS (p = 0.001), and drowsiness (p = 0.05) were independently correlated with frequency of prayer. Conclusion: The more the patients have demanding religious issues, the greater the state of anxiety, particularly in older and female patients with a lower KPS. The religious pattern did not have relevant role in the expression of other symptoms included in the ESAS.

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05 / FINANCIAL DISTRESS AMONG ADVANCED CANCER PATIENTS ASSESSED IN A SUPPORTIVE CARE OUTPATIENT CENTER.

10.26226/morressier.5afadd8af314ac000849b05f ◽

2018 ◽

Author(s):

Marvin Delgado-Guay

Keyword(s):

Supportive Care ◽

Cancer Patients ◽

Advanced Cancer ◽

Financial Distress ◽

Advanced Cancer Patients ◽

Outpatient Center

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Moderate and Severe Financial Distress Among Advanced Cancer Patients Assessed in a Supportive Care Outpatient Center

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2018.10.443 ◽

2018 ◽

Vol 56 (6) ◽

pp. e140

Author(s):

Marvin Delgado Guay ◽

Maxine G. De la Cruz ◽

Janet Williams ◽

Eduardo Bruera

Keyword(s):

Supportive Care ◽

Cancer Patients ◽

Advanced Cancer ◽

Financial Distress ◽

Advanced Cancer Patients ◽

Outpatient Center

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Frequency, intensity, and correlates of financial distress (FD) among advanced cancer patients (AdCa).

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.15_suppl.9635 ◽

2014 ◽

Vol 32 (15_suppl) ◽

pp. 9635-9635

Author(s):

Marvin Omar Delgado-Guay ◽

Jeanette Ferrer ◽

Alyssa G. Rieber ◽

Wadih Rhondali ◽

Jewel Ochoa ◽

...

Keyword(s):

Cancer Patients ◽

Advanced Cancer ◽

Financial Distress ◽

Advanced Cancer Patients ◽

Frequency Intensity

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Frequency, intensity, and correlates of spiritual pain in advanced cancer patients assessed in a supportive/palliative care clinic

Palliative & Supportive Care ◽

10.1017/s147895151500108x ◽

2015 ◽

Vol 14 (4) ◽

pp. 341-348 ◽

Cited By ~ 35

Author(s):

Marvin Omar Delgado-Guay ◽

Gary Chisholm ◽

Janet Williams ◽

Susan Frisbee-Hume ◽

Andrea O. Ferguson ◽

...

Keyword(s):

Palliative Care ◽

Cancer Patients ◽

Advanced Cancer ◽

Financial Distress ◽

Well Being ◽

Advanced Cancer Patients ◽

Care Clinic ◽

New Instrument ◽

Frequency Intensity

AbstractObjective:Regular assessments of spiritual distress/spiritual pain among patients in a supportive/palliative care clinic (SCPC) are limited or unavailable. We modified the Edmonton Symptom Assessment Scale (ESAS) by adding spiritual pain (SP) to the scale (0 = best, 10 = worst) to determine the frequency, intensity, and correlates of self-reported SP (≥1/10) (pain deep in your soul/being that is not physical) among these advanced cancer patients.Method:We reviewed 292 consecutive consults of advanced cancer patients (ACPs) who were evaluated at our SCPC between October of 2012 and January of 2013. Symptoms were assessed using the new instrument (termed the ESAS–FS).Results:The median age of patients was 61 (range = 22–92). Some 53% were male; 189 (65%) were white, 45 (15%) African American, and 34 (12%) Hispanic. Some 123 of 282 (44%) of ACPs had SP (mean (95% CI) = 4(3.5–4.4). Advanced cancer patients with SP had worse pain [mean (95% CI) = 5.3(4.8, 5.8) vs. 4.5(4.0, 5.0)] (p = 0.02); depression [4.2(3.7, 4.7) vs. 2.1(1.7, 2.6), p < 0.0001]; anxiety [4.2(3.6, 4.7) vs. 2.5(2.0, 3.0), p < 0.0001]; drowsiness [4.2(3.7, 4.7) vs. 2.8(2.3, 3.2), p < 0.0001]; well-being [5.4(4.9, 5.8) vs. 4.5(4.1, 4.9), p = 0.0136]; and financial distress (FD) [4.4(3.9, 5.0) vs. 2.2(1.8, 2.7), p < 0.0001]. Spiritual pain correlated (Spearman) with depression (r = 0.45, p < 0.0001), anxiety (r = 0.34, p < 0.0001), drowsiness (r = 0.26, p < 0.0001), and FD (r = 0.44, p < 0.0001). Multivariate analysis showed an association with FD [OR (95% Wald CI) = 1.204(1.104–1.313), p < 0.0001] and depression [1.218(1.110–1.336), p < 0.0001]. The odds that patients who had SP at baseline would also have SP at follow-up were 182% higher (OR = 2.82) than for patients who were SP-negative at baseline (p = 0.0029). SP at follow-up correlated with depression (r = 0.35, p < 0.0001), anxiety (r = 0.25, p = 0.001), well-being (r = 0.27, p = 0.0006), nausea (r = 0.29, p = 0.0002), and financial distress (r = 0.42, p < 0.0001).Significance of results:Spiritual pain, which is correlated with physical and psychological distress, was reported in more than 40% of ACPs. Employment of the ESAS–FS allows ACPs with SP to be identified and evaluated in an SCPC. More research is needed.

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