Congress Abstracts 2005

49

SYMPTOMS AT END-OF-LIFE AMONG INDIVIDUALS WITH CANCER NOT DESIGNATED AS TERMINAL. Ardith Doorenbos, RN, PhD, Barbara Given, PhD, RN, FAAN, and Charles W. Given, PhD, Michigan State University, East Lansing, MI; and Natalya Virbitsky, PhD(c), University of Michigan, Ann Arbor, MI.

A substantial body of work describes the health status of individuals with advanced cancer and receiving palliative care. Common across these reports are high levels of symptom experience at end-of-life. It is not known if the symptom reports at end-of-life are different in individuals who are not designated as terminal.

Among individuals who were not designated as terminal at the time of accrual, but who subsequently died, determine if nearness to the date of death and the level of emotional distress at the observations made nearing death affect the number and the hierarchical ordering of 21 common cancer symptoms.

Lazarus and Folkman’s stress and coping theory explains the process of adapting to various stressful events, including impact of psychological distress on the symptom experience of a life-threatening illness such as cancer.

Secondary analysis of individuals with cancer who died (N = 198), obtained from three different longitudinal studies. Individuals were recruited from cancer centers, signed consent forms, and were interviewed over the course of a year. Measures included the Symptom Experience tool, the CESD, and descriptive questions. Death certificates from a statewide registry were obtained to identify the date of death for up to 12 months after completion of the studies.

A three level Hierarchical linear model (HLM) was used for analysis. Level-1 is the hierarchical frequency of 21 symptoms. Level-2 is the equation for the trajectory of each individual representing change over time within person or the repeated measures of symptoms and depression. Level-3 explains that trajectory via person-specific characteristics. Restricted Maximum Likelihood was used as the method of estimation.

There were changes in symptom number with more patients reporting more symptoms and in the hierarchical ordering of symptom frequency as individuals with cancer approached death. Depression worsened the symptom experience.

This secondary analysis describes the changes in the number and hierarchical ordering of symptom frequency during the months prior to death. A key element of this study was that although the patients died, they had not been formally designated as terminal; they had not been referred to hospice, nor had treatment been withdrawn. Thus, this research expands our understanding of the symptom experience at end-of-life for individuals with cancer.