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Prevalence and Predictors of Symptoms in the Terminal Stage of Lung Cancer^*

A Community Study

^* From the Department of Medicine (Dr. Skaug), Haugesund Hospital, Health Region of Fonna, Haugesund; Centre for Clinical Research (Mr. Eide), Haukeland University Hospital, and Section for Epidemiology and Medical Statistics, Department of Public Health and Primary Health Care, University of Bergen, Bergen; and Department of Thoracic Medicine (Dr. Gulsvik), Institute of Medicine, University of Bergen, Bergen, Norway.

Correspondence to: Knut Skaug, MD, Haugesund Hospital, Health Region of Fonna, PO Box 2170, N-5104 Haugesund, Norway; e-mail: dr.knut{at}skaug.no

Abstract

Background: There is little knowledge concerning the prevalence and predictors of symptoms in the terminal stage of lung cancer.

Methods: We examined, retrospectively, all cases of lung cancer diagnosed from 1990 to 1996 in a defined hospital area in Norway. All medical records from general practitioners, nursing homes, and hospitals were investigated. A total of 271 cases were diagnosed, and 247 of 253 deaths (98%) were analyzed.

Results: In the terminal 8 weeks, pain was recorded in 85% of the patients, psychological symptoms (anxiety, insomnia, and/or depression) in 71%, dyspnea in 54%, neurologic symptoms in 28%, cough in 24%, nausea in 21%, and hemoptysis in 9%. Young age (p = 0.02) and small cell lung carcinoma (p = 0.03) were risk factors for psychological symptoms. Terminal dyspnea was more frequent in patients with stage III (p = 0.002) and nausea in stage IV (p = 0.02) at the time of diagnosis, while cough (p = 0.04) occurred more often in non-small cell lung carcinoma. Terminal pain was independent of gender, age, performance status, stage, and histology.

Conclusion: In a community health service encompassing all lung cancer patients, pain, psychological symptoms, and dyspnea were frequent complaints in the terminal phase. Terminal dyspnea and nausea were associated with staging at the time of diagnosis, and terminal cough and nausea were associated with histology.

Key Words: critical care • epidemiology, pulmonary • lung cancer