The ‘cluster’ of cancer symptoms often seen in the terminally ill

Cancer symptoms: Top 14 early signs to look out for

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Due to the fast-growing nature of many cancers patients are already in the terminal stages of their disease once it is caught. When a tumour has metastasised, individuals report various physical and mental symptoms related to their disease. According to some research, patients afflicted by specific symptom combinations may have a greater risk of death than others.

The prevalence of singular symptoms in advanced cancer is well studied, but literature on symptom combinations is scarce.

  • Anxiety and depression
  • Nausea and vomiting
  • Nausea and appetite loss
  • Fatigue, dyspnea, drowsiness and pain.

This is according to a review published in the Journal of Pain Symptom Management in 2014.

Few of the studies included in the review, however, were conducted on terminally ill patients.

To tackle the research gap, a study published in the Supportive Care in Cancer in 2021, focussed on determining the frequency of different symptom combinations in terminally ill patients.

To do this, researchers investigated symptom clusters in cancer patients at the time of hospitalisation in palliative care units.

Another aim of the study was to examine whether the symptoms clusters were linked to the patient’s survival prediction.

Three major symptom clusters were identified. 

A symptoms cluster was defined as two or more interrelated symptoms that are present together, independent of other symptom clusters.

  • Cluster one contained pain, emotional functioning (feeling tense and depressed), and insomnia
  • Cluster two contained fatigue, dyspnea, appetite loss and nausea
  • Cluster three contained the three items of physical functioning (short walk, in bed, and a need for help).

According to the findings, the deadliest combination of symptoms could be those described in cluster 2, as these were significantly associated with an increased risk of death.

Those who had signs described in cluster two had a two-fold increased risk of death compared to patients who did not.

The survival trends for cluster one and cluster three, on the other hand, were not too dissimilar.

In past studies, researchers assessing the prevalence of different symptoms in terminally ill patients have largely focussed on individual symptoms.

Many of the scientific findings, including those published in Lancet Oncology, suggest that certain symptoms may be associated with increased odds of stage IV cancer.

The cross-sectional study found that the “proportion of patients diagnosed with stage IV cancer varied substantially by presenting symptoms”.

In fact, the likelihood of a stage IV diagnosis varied from one percent for abnormal moles to 80 percent for neck lumps.

“In our population-based cohort of patients with cancer, certain presenting symptoms such as neck lumps, had stronger associations with stage IV disease than others […],” noted the authors.

Though these symptoms are commonly seen in terminally ill cancer patients, they do not necessarily expedite the detection of advanced disease.

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