The Symptom Burden of Patients with Hematological Malignancy: A Cross-Sectional Observational Study

Context. Current literature suggests that contact with specialist palliative care for patients diagnosed with hematological malignancy is infrequent. As part of an investigation into patterns of care, the symptom profile of this patient group required elucidation. Objectives. The purpose of this study was to determine the patterns of symptoms and level of distress in patients diagnosed with a hematological malignancy. Methods. One hundred eighty patients diagnosed with a hematological malignancy attending a tertiary referral hospital completed the Memorial Symptom Assessment Scale-Short Form. Comparisons were made to published symptom prevalence studies of those with nonhematological malignancies. Results. Patients with hematological malignancy had a considerable physical and psychological symptom burden, with an overall mean of 8.8 (+/- 5.9) symptoms. The mean number of symptoms was significantly greater in those on treatment (P < 0.05), those with poorer performance status (P < 0.001), inpatients (P < 0.01), and those with a more advanced disease stage (P < 0.001) than their respective counterparts. Symptom prevalence ranged from 69% for fatigue to 9% for vomiting. Global, physical, and psychological distress scores were high and varied significantly according to disease stage, Eastern Cooperative Oncology Group status, and patient location. The mean number of symptoms and level of distress were comparable to those patients with metastatic nonhematological malignancy. Conclusion. Patients with hematological malignancy are likely to have symptom control needs similar to those with metastatic cancer. Because such symptom burden appears to affect those at all phases of illness, comprehensive symptom assessment is suggested throughout. The introduction of palliative care services during times of increased symptom burden may assist hematologists and other carers in the management of their patients' distress and quality of life. J Pain Symptom Manage 2011;42:432-442. Crown Copyright (C) 2011 Published by Elsevier Inc. on behalf of U.S. Cancer Pain Relief Committee. All rights reserved.