Symptom Distress and Quality of Life in Patients With Cancer Newly Admitted to Hospice Home Care

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Abstract
To evaluate the relationships between quality of life (QOL) and symptom distress, pain intensity, dyspnea intensity, and constipation intensity in people with advanced cancer who were newly admitted to hospice home care. Descriptive and correlational. A large hospice that provides primarily home care. 178 adult hospice homecare patients with cancer who were accrued to a clinical trial funded by the National Institutes of Health focusing on symptom management and QOL. Patients were excluded if they received a score lower than seven on the Short Portable Mental Status Questionnaire. The patients were invited to participate in the clinical trial within 48 hours of admission to hospice home care. Among the questionnaires they completed were a QOL index and a distress scale. Scales measuring present intensity of pain, dyspnea, and constipation also were administered. QOL, symptom distress, pain intensity, dyspnea intensity, and constipation intensity. The most frequently reported symptoms among the sample were lack of energy, pain, dry mouth, and shortness of breath. Lack of energy caused the greatest distress, followed closely by dry mouth and pain. The results of the regression analysis indicated that total distress score, pain intensity, dyspnea intensity, and constipation intensity were related to QOL at the univariate level. When all predictors were considered simultaneously, only the total distress score remained a significant predictor of QOL (p< 0.001), accounting for about 35% of variance. QOL was affected by symptom distress in people with advanced cancer near the end of life. The symptoms most commonly reported and those that cause the greatest patient distress should be addressed first by hospice nurses. Continued effort is needed in the important area of symptom management.