The prevalence and burden of symptoms amongst cancer patients attending palliative care in two African countries

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Abstract

Background

The majority of cancer presentations in Africa are advanced and incurable, with incidence of malignancies projected to increase significantly. Despite the African cancer burden, almost nothing is known about the symptomatology of malignant progressive disease. This study aimed to determine the symptom prevalence and burden amongst advanced cancer patients in two African countries.

Methods

The Memorial Symptom Assessment Schedule Short Form (MSAS-SF) was used to measure the 7-d period prevalence and associated burden of multidimensional symptoms amongst adult patients attending palliative care in South Africa and Uganda. Further demographic and clinical variables were collected.

Results

Of the 112 patients recruited, 22 (19.6%) had an underlying HIV diagnosis. The most common cancer primaries were breast (N = 24), cervix (N = 21) and lung (N = 14). The mean number of symptoms was 18 (SD = 6.6). The five most prevalent symptoms were pain (87.5%), lack of energy (77.7%), feeling sad (75.9%), feeling drowsy (72.3%) and worrying (69.6%). The five symptoms ranked as most severe were as follows: pain n = 26 (23.2%), sexual problems n = 24 (21.4%), weight loss n = 21 (18.8%), ‘I don’t look like myself’ n = 21 (18.8%) and lack of energy n = 20 (17.9%).

Discussion

Pain and psychological problems were four of the five most common symptoms, found in more than 3 out of 4 patients. Our sample’s reported mean number of symptoms was far higher than reported in other global studies. These data can inform the delivery of appropriate clinical care. The prevalence of multidimensional symptoms underlines the importance of holistic approaches to patient assessment and management, taking account of multiple and potentially interacting symptoms and locally appropriate intervention.

Section snippets

Background

The lack of developed cancer registries in many countries in Africa hampers the collection of robust surveillance data to determine incidence and mortality, with fewer than 1% of abstracts within the global cancer registration literature originating from Africa.1 Data to inform evidence-based clinical practice are urgently needed to improve outcomes for Africans affected by cancer, as by 2030 the developing world is expected to bear 70% of the global cancer burden.2 GLOBCAN estimates that there

Methods

This study used an international multi-centred cross-sectional design utilising a well-validated cancer symptom scale.

Sample characteristics

One hundred and twelve cancer patients were recruited. The mean age was 56.6 years (SD = 15.8), and 72 (64.3%) were female. The place of care and recruitment was as follows: home care n = 94 (83.9%), inpatient n = 8 (7.1%), outpatient 9 (8.0%), daycare n = 1 (1.9%). Patients had been under palliative care for a median 52 weeks. Respondents’ home location was: urban n = 49 (43.8%); peri-urban n = 31 (27.7%); rural n = 32 (28.6%). Of the 112 patients, n = 73 (65.2%) were responsible for children (mean number of

Discussion

The data presented in this paper are the first to determine the symptom prevalence and burden amongst advanced cancer patients in Sub-Saharan Africa. It is interesting to note that pain and psychological problems were three of the five most common symptoms, found in more than two out of three patients. These data can inform the planning and delivery of appropriate care for Africans with advanced cancer.

We have compared our findings to available MSAS data reporting cancer patient studies: 66

Author contributions

The study was conceived by RH and IJH, design input by all authors, analysis conducted by RH and LS, all authors commented on further analysis and interpretation, and on draft manuscript.

Conflict of interest statement

The authors declare that they have no conflicting interests.

Acknowledgements

We are grateful to the BIG Lottery Fund UK for supporting this study under grant number IG/1/010141040. We would also like to acknowledge the clinical teams in each participating site who assisted in recruitment and to the patients and families who agreed to give data. The study sponsor (the BIG Lottery Fund UK) had no role in study design; the collection, analysis and interpretation of data; the writing of the report or the decision to submit the paper for publication.

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