MONDAY, June 26, 2004 (HealthDayNews) -- Terminal cancer patients may feel anxious or spiritually distressed, but their physical symptoms -- not their emotions -- are what signal the beginning of the end, an international research team reports.

In the early stages of terminal cancer, patients with intense nausea are 70 percent more likely to die within six months than patients without that symptom, researchers report in the July 26 online edition of Cancer.

In late-stage cancer, shortness of breath was associated with a 50 percent increase in patients' immediate risk of dying, they found.

These physical symptoms appear to reflect the severity of a patient's cancer cachexia, a wasting syndrome that causes people with tumors to become anorexic, weak and fatigued.

"The presence of these symptoms should be like red flags," indicating that a patient's cancer is more advanced than it might otherwise appear, explained study author Dr. Antonio Vigano, an assistant professor in the Palliative Care Division of McGill University Health Center in Montreal.

"I think that patients presented with these symptoms should be referred earlier to palliative care, and treatment to improve the symptoms should be started earlier rather than later," he said.

The study is important because it scientifically supports what health professionals who work with advanced cancer patients already know, said Dr. Robert A. Brescia, director of the Palliative Care Institute at Calvary Hospital in the Bronx, which provides end-of-life care to adults with advanced cancer.

"Cancer patients often suffer increasing physical distress -- including shortness of breath, weakness, nausea and vomiting -- as they get closer to death," he noted.

Nevertheless, Brescia cautions against focusing on risk of death in dealing with patients and their families.

"It is very risky, and often inappropriate, to try and predict how long any particular patient has to live," he asserted. "Even the most experienced clinicians will tell you that this is difficult to do, and attempting to do so can unwittingly add to the suffering of both the patient and family."

Existing research suggests that patients' physical symptoms, not their emotions, are good predictors of how long they will live. But because those studies failed to use precise research methods, the results were questionable.

To clarify the issue, Vigano and colleagues studied two groups of terminal cancer patients at different stages of the disease. One group included 248 patients admitted to Cross Cancer Institute in Edmonton, Alberta, at the onset of terminal cancer. The other group represented 756 new referrals to palliative home-care services in Southern Ireland; these people were cared for in the later stages of their disease.

Investigators examined the relationship between how long the patients lived and various quality-of-life measures, including physical and emotional symptoms. At each stage of the disease, physical factors predicted shorter survival.

For patients in the early stages of terminal cancer, risk of death increased 68 with nausea or vomiting and 28 percent with shortness of breath. But these associations were not as strong as other disease-related factors.

For example, the risk of dying almost tripled for patients with liver metastases -- malignant tumors that originated elsewhere in the body and spread to the liver through the bloodstream.

Death risk doubled for patients with high tumor burden, a measure that approximates the number of tumors they have, including primary tumors and secondary tumors that form as the cancer spreads.

Among later-stage cancer patients, weakness, meaning a general lack of energy, boosted chances of dying by three, four and five times, respectively, for people with late-stage colorectal, genitourinary (including bladder, uterine, kidney, and prostate cancers) and breast cancer.

If health-care providers are able to identify these symptoms, they can intervene in a way that will improve cancer patients' quality of life, Vigano said.

Although anxiety and spiritual distress were not predictors of survival, Brescia nevertheless favors aggressively treating patients' psychological symptoms.

"These symptoms often cause the patient and family even more pain and suffering than physical symptoms and too often are completely ignored by health-care professionals," he explained.

In a separate study in the same edition of Cancer, Dr. Gopal K. Singh and colleagues from the National Cancer Institute report a link between income and education in cervical cancer patients. The study shows that the incidence and death rates for cervical cancer rose with increasing poverty and decreasing education levels.

More information

Visit the American Cancer Society for more on coping with cancer's physical and emotional aspects.

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