Qdaisat Aiham, Stroh Elizabeth, Reyes-Gibby Cielito, Wattana Monica K, Viets-Upchurch Jayne, Li Ziyi, Page Valda D, Fatima Huda, Chaftari Patrick, Elsayem Ahmed
Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Cancers (Basel). 2024 Nov 28;16(23):3988. doi: 10.3390/cancers16233988.
: Patients with advanced cancer often present to the emergency department (ED) with pain and distressing symptoms that are not systematically evaluated. The current study investigated the association of symptom severity with the diagnosis of delirium and short-term survival. : In this secondary analysis of a prospective randomized study of delirium among advanced cancer patients in the ED, in which symptoms were assessed by the MD Anderson Symptom Inventory (MDASI), we analyzed the distribution of MDASI item scores by 90-day mortality (Kolmogorov-Smirnov), the association of MDASI item scores with short-term mortality (logistic regression models), and the symptoms in those with or without delirium (Mann-Whitney U test or chi-square test). : Of the 243 patients included, 222 (91.4%) had complete MDASI scores. The MDASI median symptom scores for pain, fatigue, and interference with work were the highest. A significant difference in MDASI item score distribution with 90-day mortality was observed for fatigue ( = 0.018), shortness of breath ( < 0.001), difficulty remembering ( = 0.038), lack of appetite ( = 0.035), drowsiness ( < 0.001), feeling sad ( = 0.031), and interference with walking ( < 0.001). In multivariable logistic regression models, shortness of breath (adjusted OR 1.15, 95% CI 1.04-1.26, = 0.005) and drowsiness (adjusted OR 1.17, 95% CI 1.05-1.33, = 0.008) were associated with 90-day mortality, adjusting for age, race, performance status, and cancer type. The median total MDASI score was significantly higher in patients with delirium than in those without (88, IQR 83-118 vs. 80, IQR 55-104; < 0.001). : Patients with advanced cancer presenting to the ED had severe symptoms, some of which were associated with shorter survival. These findings underscore the necessity of systematic symptom assessment, focusing on shortness of breath, drowsiness, fatigue, difficulty remembering, lack of appetite, feeling sad, and feeling distressed, to enhance clinical decision-making and improve the care of patients with advanced cancer. Additional longitudinal studies are needed to evaluate the improvement in symptoms and quality of life for these patients.
晚期癌症患者常因疼痛和令人痛苦的症状前往急诊科（ED），但这些症状并未得到系统评估。本研究调查了症状严重程度与谵妄诊断及短期生存之间的关联。
在这项对急诊科晚期癌症患者谵妄的前瞻性随机研究的二次分析中，通过MD安德森症状量表（MDASI）评估症状，我们分析了按90天死亡率划分的MDASI项目得分分布（柯尔莫哥洛夫-斯米尔诺夫检验）、MDASI项目得分与短期死亡率的关联（逻辑回归模型），以及有或无谵妄患者的症状（曼-惠特尼U检验或卡方检验）。
在纳入的243例患者中，222例（91.4%）有完整的MDASI得分。疼痛、疲劳及对工作的干扰方面的MDASI症状得分中位数最高。在疲劳（P = 0.018）、气短（P < 0.001）、记忆困难（P = 0.038）、食欲缺乏（P = 0.035）、嗜睡（P < 0.001）、悲伤情绪（P = 0.031）及行走干扰（P < 0.001）方面，观察到MDASI项目得分分布与90天死亡率存在显著差异。在多变量逻辑回归模型中，调整年龄、种族、体能状态和癌症类型后，气短（调整后比值比1.15，95%置信区间1.04 - 1.26，P = 0.005）和嗜睡（调整后比值比1.17，95%置信区间1.05 - 1.33，P = 0.008）与90天死亡率相关。谵妄患者的MDASI总得分中位数显著高于无谵妄患者（88，四分位数间距83 - 118 vs. 80，四分位数间距55 - 104；P < 0.001）。
前往急诊科的晚期癌症患者有严重症状，其中一些与较短生存期相关。这些发现强调了系统症状评估的必要性，重点关注气短、嗜睡、疲劳、记忆困难、食欲缺乏、悲伤情绪和痛苦情绪，以加强临床决策并改善晚期癌症患者的护理。需要进一步的纵向研究来评估这些患者症状和生活质量的改善情况。
