Most Common Advanced Cancer Symptom: Pain

CLEVELAND, Ohio—Pain is the most common symptom of patients with advanced cancer, followed by fatigue. Other common symptoms, in order of frequency, are anorexia, dry mouth, constipation, early satiety, dyspnea, weight loss, sleep problems, and depression, Kristine A. Nelson, MD, said at a symposium on palliative medicine held at the Cleveland Clinic Foundation.

A study of 1,000 patients with advanced cancer conducted at the Cleveland Clinic identified these 10 symptoms as the most common (Donnelly S et al: Journal of Palliative Care 11:27-32, 1995). A majority of patients described them as moderate to severe. “These are significant symptoms,” Dr. Nelson said.

Even patients who are just beginning cancer treatment with a good prognosis exhibit many of these symptoms, Dr. Nelson said. Indeed, more symptoms are apparent in early stages of cancer than later stages.

Symptoms affect quality of life and can become more severe with advanced cancer. Some symptoms can be anticipated and prevented. For these reasons, the physician should take a problem-solving diagnostic approach to symptom management, Dr. Nelson said. The physician should regularly ask patients what symptoms they are experiencing, consider psychological influences on symptoms, and treat all symptoms aggressively using the least invasive techniques possible.