Background/Objectives: Patients with advanced cancer often present to the emergency department (ED) with pain and distressing symptoms that are not systematically evaluated. The current study investigated the association of symptom severity with the diagnosis of delirium and short-term survival.Methods: In this secondary analysis of a prospective randomized study of delirium among advanced cancer patients in the ED, in which symptoms were assessed by the MD Anderson Symptom Inventory (MDASI), we analyzed the distribution of MDASI item scores by 90-day mortality (Kolmogorov–Smirnov), the association of MDASI item scores with short-term mortality (logistic regression models), and the symptoms in those with or without delirium (Mann–Whitney U test or chi-square test).Results: Of the 243 patients included, 222 (91.4%) had complete MDASI scores. The MDASI median symptom scores for pain, fatigue, and interference with work were the highest. A significant difference in MDASI item score distribution with 90-day mortality was observed for fatigue (p= 0.018), shortness of breath (p< 0.001), difficulty remembering (p= 0.038), lack of appetite (p= 0.035), drowsiness (p< 0.001), feeling sad (p= 0.031), and interference with walking (p< 0.001). In multivariable logistic regression models, shortness of breath (adjusted OR 1.15, 95% CI 1.04–1.26,p= 0.005) and drowsiness (adjusted OR 1.17, 95% CI 1.05–1.33,p= 0.008) were associated with 90-day mortality, adjusting for age, race, performance status, and cancer type. The median total MDASI score was significantly higher in patients with delirium than in those without (88, IQR 83–118 vs. 80, IQR 55–104;p< 0.001).Conclusions: Patients with advanced cancer presenting to the ED had severe symptoms, some of which were associated with shorter survival. These findings underscore the necessity of systematic symptom assessment, focusing on shortness of breath, drowsiness, fatigue, difficulty remembering, lack of appetite, feeling sad, and feeling distressed, to enhance clinical decision-making and improve the care of patients with advanced cancer. Additional longitudinal studies are needed to evaluate the improvement in symptoms and quality of life for these patients.
背景/目的：晚期癌症患者常因疼痛和痛苦症状就诊于急诊科，但这些症状未得到系统性评估。本研究探讨了症状严重程度与谵妄诊断及短期生存率之间的关联。 方法：本研究为一项关于晚期癌症患者急诊科谵妄的前瞻性随机研究的二次分析，采用MD安德森症状评估量表（MDASI）评估症状。我们分析了MDASI各条目评分在90天死亡率中的分布（Kolmogorov–Smirnov检验）、MDASI条目评分与短期死亡率的关联（逻辑回归模型），以及有无谵妄患者的症状差异（Mann–Whitney U检验或卡方检验）。 结果：在纳入的243例患者中，222例（91.4%）具有完整的MDASI评分。MDASI中疼痛、疲劳和工作干扰的中位症状评分最高。疲劳（p=0.018）、气短（p<0.001）、记忆困难（p=0.038）、食欲不振（p=0.035）、嗜睡（p<0.001）、悲伤感（p=0.031）和行走干扰（p<0.001）的MDASI条目评分分布在90天死亡率中存在显著差异。在多变量逻辑回归模型中，调整年龄、种族、体能状态和癌症类型后，气短（校正OR 1.15，95% CI 1.04–1.26，p=0.005）和嗜睡（校正OR 1.17，95% CI 1.05–1.33，p=0.008）与90天死亡率相关。谵妄患者的中位MDASI总分显著高于非谵妄患者（88，IQR 83–118 vs. 80，IQR 55–104；p<0.001）。 结论：就诊于急诊科的晚期癌症患者症状严重，其中部分症状与较短的生存期相关。这些发现强调了系统性症状评估的必要性，应重点关注气短、嗜睡、疲劳、记忆困难、食欲不振、悲伤感和痛苦感，以优化临床决策并改善晚期癌症患者的护理。未来需开展更多纵向研究以评估这些患者症状和生活质量的改善情况。
肿瘤(癌症)患者之家