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Gastrointestinal symptoms among inpatients with advanced cancer

The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio

Kristine A. Nelson, MD

Board of Scientific Counselors, Cancer Treatment Research Foundation, Arlington Heights, Illinois

Declan Walsh, MSc, FACP, FRCP (Edin)

Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Center, Cleveland, Ohio, Ohio State University, Columbus, Ohio

Rashawn Bradley Ford

The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Center, Cleveland, Ohio

Lisa A. Rybicki, MS

Department of Biostatistics, Cleveland Clinic Taussig Center, Cleveland, Ohio

Nearly one-half of the most frequently reported and most distressing symptoms in patients with advanced cancer are gastrointestinal in nature. This prospective study was designed to assess the frequency of gastrointestinal symptoms among inpatients admitted to a palliative medicine program with advanced cancer.

Twenty-nine men and 21 women, with a median age of 64 years (range, 35-84), were interviewed about 17 gastrointestinal symptoms. Age, gender, diagnosis, and medication use were also recorded.

The most common diagnoses were cancers of the lung (n = 14), breast (n = 6), and prostate (n = 4). Dry mouth (84 percent), weight loss (76 percent), early satiety (71 percent), taste change (60 percent), constipation (58 percent), anorexia (56 percent), bloating (50 percent), nausea (48 percent), abdominal pain (42 percent), and vomiting (34 percent) were the 10 most common gastrointestinal symptoms. Women had more gastrointestinal symptoms than men (median 8 vs. 6, p = 0.018), although this finding was not statistically significant (p = 0.11) after excluding gender-specific cancers. Women had more taste change and diarrhea than men after excluding gender-specific cancers (p = 0.036 and p = 0.046, respectively). Those with primary gastrointestinal cancers (n = 8) had more indigestion and hiccups than those with nongastrointestinal cancers (n = 39). There was no age difference in symptomatology. The drugs prescribed most commonly were opioids (n = 40), laxatives (n = 38), H₂ blockers (n = 29), appetite stimulants (n = 29), and antiemetics (n = 29).

Findings support that gastrointestinal symptoms are very common in hospitalized patients with advanced cancer and that the frequency and type of symptoms differ with gender and gastrointestinal vs. nongastrointestinal primary site.

Key Words: cancer • gastrointestinal symptoms • gender-specific symptoms

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