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Medline ® Abstract for Reference 26

of 'Cancer pain management: General principles and risk management for patients receiving opioids'

Somatic symptoms in patients with cancer experiencing pain or depression: prevalence, disability, and health care use.
Kroenke K, Zhong X, Theobald D, Wu J, Tu W, Carpenter JS
Arch Intern Med. 2010;170(18):1686.
BACKGROUND: The adverse impact of a high somatic symptom burden is well established for primary care and other noncancer populations with chronic medical disorders.
METHODS: This study examines the impact of somatic symptom burden on disability and health care use in patients with cancer experiencing pain, depression, or both. We performed secondary analyses of baseline data from 405 patients with cancer enrolled in a telecare management trial for pain or depression. Somatic symptom burden was measured using a 22-item scale. Multivariable models were conducted to determine the association of somatic symptom burden with the Sheehan Disability Scale (SDS) score, the number of self-reported disability days in the past 3 months, and health care use. Models were adjusted for sociodemographic characteristics, medical comorbidity, and depression and pain severity.
RESULTS: Somatic symptoms were highly prevalent, with 15 of the 22 symptoms reported by more than 50% of patients. The somatic symptom burden was similar across different types and phases of cancer. The mean SDS score (scored 0-10 [not at all disabled to unable to carry out any activities]) was 5.4, and the mean number of self-reported disability days in the past 4 weeks was 16.9. In multivariable models, somatic symptom burden was associated with SDS score (P<.001) and the likelihood of at least 14 disability days in the past 4 weeks (odds ratio, 1.51; 95% confidence interval, 1.19-1.92) but not with increased health care use.
CONCLUSIONS: The somatic symptom burden is high in patients with cancer who experience pain or depression. Given the strong association with disability and the high prevalence of many types of symptoms, recognizing and managing somatic symptoms may be important in improving quality of life and functional status regardless of type or phase of cancer. Trial Registration clinicaltrials.gov Identifier: NCT00313573.
Richard Roudebush VA Medical Center, Indianapolis, USA. kkroenke@regenstrief.org