Malignant Ascites Symptom Cluster in Patients Referred for Paracentesis

Background. Malignant ascites (MA) is a distressing problem usually managed by repeated paracenteses. Paracentesis represents a meaningful time point in identifying patients with a specific presentation. Objective. The objective of this study is to examine symptom clustering in MA patients at paracentesis. Methods. Pre- and post-paracentesis, patients completed the Edmonton Symptom Assessment Scale revised to include abdominal distension and mobility (ESAS:AM) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). This is a secondary analysis of data previously published, which reported on the validity of these surveys in MA. The symptoms were clustered using a hierarchical cluster analysis technique. Results. In 37 cancer patients with complete data, there were two clusters common at both pre- and post-paracentesis time points: (1) depression-anxiety; (2) fatigue appetite-wellbeing-mobility. Paracentesis resulted in an improvement in ESAS/AM total score (SDS/AM), abdominal distension, and shortness of breath (P < 0.001, threshold adjusted for multiple comparisons). On the EORTC QLQ-C30, the domains of role functioning and global quality of life (QOL) showed a trend towards improvement, while the domains of cognitive and emotional QOL declined significantly (P < 0.001, threshold adjusted for multiple comparisons), despite improvement in individual symptoms commonly attributed to ascites. Conclusions. This study is the first to describe symptom clusters in MA. Studies in MA should include measurement of the more global symptoms of fatigue, wellbeing, depression, and anxiety in addition to shortness of breath, abdominal distension, and mobility. Patients presenting with MA require a comprehensive assessment and a management plan that addresses QOL and the emotional domain symptoms shown to cluster in these patients.