The role of physical and psychological symptoms in desire for death: A study of terminally ill cancer patients

The current study assessed the attitudes of the desire for hastened death in terminally ill cancer patients and whether these are determined by their physical and psychological symptoms. The final sample consisted of 106 terminally ill cancer patients attending a Palliative Care Unit, in University of Athens, Greece, between June and October 2004. Significant associations were found between the desire for hastened death (D.H.D.) and 'pain' (r = 0.469, p < 0.005), 'fatigue' (r = 0.591, p<0.0005), 'loss of appetite' (r = 0.622, p<0.0005) and 'feeling sad' (r = 0.635, p<0.0005). Statistically significant associations were also found between Schedule of Attitudes towards Hastened Death (SAHD) scores, age (r = 0.300, p = 0.002) and ECOG (p < 0.0005). Twenty-six percent of the patients reported high D.H.D. while 41% reported moderate desire. In the prediction of SHAD the contribution of'pain' (p = 0.011), 'lack of appetite' (p = 0.012) and 'sadness' (p = 0.011) is high (42% of variance). Further findings suggest that D.H.D. is significantly related to 'feeling sad', 'lack of appetite', 'pain' and 'fatigue' after controlling for age, gender and performance status according to ECOG in terminally ill cancer patients. Copyright © 2005 John Wiley & Sons, Ltd

Pain and desire for hastened death in terminally ill cancer patients

The purpose of this study was to assess the relationship between pain and the desire for hastened death in terminally ill cancer patients. The participants were 120 terminally ill cancer patients under palliative treatment from June 2003 to November 2004. Patients completed a pain assessment tool, the Greek Brief Pain Inventory (G-BPI), and a self-report measure of the desire for hastened death, the Greek Schedule of Attitudes Toward Hastened Death (G-SAHD). Moderate but statistically significant associations were found between some of the severity and interference items of G-BPI and G-SAHD; more specifically, between G-SAHD and G-BPI3, "worst pain in the last 24 hours" (r = 0.279, P = .002); G-SAHD and G-BPI4, "least pain in the last 24 hours" (r = 0.253, P = .005); and G-SAHD and G-BPI5, "average pain in the last 24 hours" (r = 0.283, P = .002). A stronger association was revealed between G-SAHD and G-BPI8, "relief provided by pain treatment and medications in the last 24 hours" (r = -0.326, P = .000). Multiple regression analyses including the enter model and the forward model were conducted. According to the enter model, the strongest predictors of hastened death were items G-BPI6, "current pain"; G-BPI8, "relief provided by pain treatment and medications in the last 24 hours"; G-BPI9i, "interference of pain in general activity"; and G-BPI9iii, "interference of pain in walking." According to the forward model, significant predictors of the desire for death were items G-BPI5, "average pain in the last 24 hours"; G-BPI6, "current pain"; G-BPI9i, "interference of pain in general activity"; and G-BPI9ii, "interference of pain in mood," all of which were statistically significant (P = .000-.042). Pain appeared to have a statistically significant relationship with the desire for hastened death. Effective treatment by healthcare professionals should be provided to reduce pain and cancer-related symptoms as well as the desire for hastened death. © 2005 Lippincott Williams & Wilkins, Inc

Influence of pain and quality of life on desire for hastened death in patients with advanced cancer.

OBJECTIVE: to assess the relationship between quality of life, pain and desire for hastened death in advanced cancer patients. METHODS: 120 Greek patients with advanced cancer were interviewed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 version 3.0 (EORTC QLQ-C30), the Greek Brief Pain Inventory (G-BPI), the Greek Hospital Anxiety and Depression Scale (G-HADS) and the Greek Schedule of Attitudes toward Hastened Death (G-SAHD). RESULTS: statistically significant associations were found between total G-SAHD scores and scores for the worst level of pain in the previous 24 hours (G-BP13) (r = 0.279, P = 0.002), and between total G-SAHD scores and scores for the level of pain relief obtained in the last 24 hours (G-BP18) (r = -0.326, P = 0.0005). The strongest correlations were found between G-SADH and emotional functioning (r = 0.569, P<0.0001) and global quality of life (r = -0.331, P<0.0001) from EORTC QLQ-C30. In multivariate analyses, emotional functioning, social functioning, financial impact, and the interference of pain in general activity and mood were significant predictors of G-SAHD (all P<0.0001). CONCLUSION: quality of life and pain appeared to have a statistically significant relationship with desire for hastened death. Adequate palliative care should alleviate pain and the desire for hastened death, improving quality of life

Randomized, open label, prospective study on the effect of zoledronic acid on the prevention of bone Metastases in patients with recurrent solid tumors that did not present with bone metastases at baseline

Objectives: Bisphosphonates have been used successfully in the treatment of hypercalcemia and to reduce skeletal-related complications of bone metastases. Recent in vitro and in vivo evidence suggest that they may also have direct antitumor effects via induction of apoptosis, inhibition of the invasive potential of tumor cell lines in vitro, inhibition of angiogenesis, and reduction in tumor growth indirectly via effects on accessory cells. This is a randomized, open label, prospective study that examined the effect of preventive zoledronic acid treatment on the development of bone metastases in patients with recurrent solid tumors, without bone metastases at the time of randomization. Methods: Forty patients with recurrent or metastatic advanced cancer, without bone metastases, were randomized into the trial to either receive zoledronic acid or no treatment. Patients were followed up until bone metastases were established. Results: The percentage of patients being bone metastases free at 12 mo was 60% in the zoledronic acid and 10% in the control group (p < 0.0005), while the percentages at 18 mo were 20% and 5% respectively (p = 0.0002). Conclusions: The results have shown that bisphosphonates as adjuvant treatment might be useful for the prevention of bone metastases; however, there is need for blinded randomized data before such an approach would be confirmed. In the meantime preventive use of bisphosphonates in patients without any bone metastases should not be used outside the scope of a clinical trial

Assessment of anxiety and depression in advanced cancer patients and their relationship with quality of life

The growing interest in the mental health and quality of life of cancer patients, has been the major reason for conducting this study. The aims were to compare advanced cancer patients’ responses to Hospital Anxiety and Depression (HAD) scale with those to European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30, version 3.0), as well as the impact of quality of life dimensions (as measured by EORTC QLQ-C30) on the levels of anxiety and depression. The analysis, conducted in 120 advanced cancer patients, showed that the most significant associations were found between emotional functioning and HAD-T (total sum of scores) (r=-0.747; p < 0.0005), HAD-A (anxiety) (r=-0.725; p < 0.0005) and HAD-D (depression) (r=-0.553; p < 0.0005). In the prediction of HAD-T, the contribution of physical, emotional, role, and social functioning along with nausea-vomiting, dyspnea, sleep disturbance and gender is high. For anxiety, the predictor variables were physical, role, cognitive, emotional, and social functioning, followed by dyspnea, sleep disturbance, and appetite loss, while depression was predicted by physical, role, emotional, and social functioning, the symptoms of nausea-vomiting, pain, sleep disturbance, constipation, as well as the variables of age, gender, anticancer treatment and performance status. Concluding, psychological morbidity, in this patient population, was predominantly predicted by the emotional functioning dimension of EORTC QLQ-C30

Prophylactic tropisetron versus rescue tropisetron in fractionated radiotherapy to moderate or high emetogenic areas: A prospective randomized open label study in cancer patients

Aim: A prospective randomized open label study was carried out to evaluate the efficacy and effectiveness of prophylactic tropisetron versus rescue tropisetron in fractionated radiotherapy. Patients and Methods: The study sample consisted of 288 cancer patients randomly allocated (3:4 ratio) into two treatment groups: 120 patients received prophylactic antiemetic treatment with tropisetron and 168 patients received rescue tropisetron. To determine the efficacy of prophylactic antiemetic treatment, nausea and vomiting were evaluated 1 d before radiation therapy (RT), at 24 and 72 h, at the end of every week during RT, and finally 1 wk after RT. Diary cards were used to record the intensity of nausea and vomiting as well as the incidence of adverse effects. Results: In the odds of nausea and vomiting, statistically significant differences were found between the two treatment groups over time. The incidence of nausea and vomiting were 1.89 (p = 0.009) and 2.19 (p = 0.001) times higher in the rescue tropisetron group than in the prophylactic tropisetron group. Factors that related significantly with increased nausea were primary cancer, rescue tropisetron, and radical RT. Moreover, factors for vomiting were primary cancer type, metastasis, palliative RT, and rescue tropisetron. Conclusions: Higher numbers of patients receiving prophylactic tropisetron completed RT with lower incidence of nausea and vomiting than those in the rescue tropisetron group. © Copyright 2005 by Humana Press Inc. All rights of any nature whatsoever reserved

Demographic and clinical predictors of preparatory grief in a sample of advanced cancer patients

Background: Preparatory grief encompasses grief for losses that have already occurred, are currently being experienced, and losses that will or might ensue in the future after the death, as a consequence of it. Aim: To examine the relative contribution of demographic and clinical variables in predicting cancer patients' preparatory grief as recorded from the Preparatory Grief in Advanced Cancer Patients (PGAC) scale. Moreover, researchers were interested in determining whether these dimensions were independently and uniquely associated with preparatory grief. Methods: Two hundred advanced cancer patients treated in a Pain Relief and Palliative Care Unit completed the PGAC scale, while researchers recorded data on demographic characteristics, disease status and treatment regimen. Results: The analyses showed that the most significa nt correlations were found between preparatory grief and age (r = -0.227, p = 0.001), gender (p = 0.006), family status (p = 0.019), performance status (p = 0.010), surgery (p = 0.029), opioids (p = 0.019), and diagnosis (p = 0.038). In the prediction of preparatory grief, the contribution of age, performance status, history of other surgery, gender and opioids is high. Conclusions: Awareness of the specific patients' demographic and medical characteristics, such as old age, poor performance status, history of other surgery, female gender, and strong opioids, contribute to the prediction of patients' preparatory grief. Copyright © 2006 John Wiley & Sons, Ltd

Desire for death near the end of life: the role of depression, anxiety and pain

Objective: This study evaluated the desire of patients with advanced cancer for hastened death to determine its relationship to psychological distress, anxiety and pain. Methods: One hundred twenty terminally ill cancer patients were surveyed from June to November 2003 at a palliative care unit in Athens, Greece. Greek versions of the Schedule of Attitudes Toward Hastened Death (G-SAHD), the Hospital Anxiety and Depression Scale (G-HADS) and the Brief Pain Inventory were administered. Results: Significant correlations were seen between desire for hasten death and HADS-Depression (r = .605. P < .0005) and GADS-Anxiety (r = .636; P < .0005) scores. Results of multiple regression analyses showed that the HADS-Depression scale (B = .443, P < .0005) as well as the HADS-Anxiety scale (B = .326; P < .0005) and the interaction between HADS-Depression and opioids (B = .459, P = .012), but not pain intensity, pain-related interference, age, sex, patient’s performance status as defined by the Eastern Cooperative Oncology Group as well as the interactions between average pain and opioids and average pain and HADS-Depression, were significant predictors of G-SAHD scores. Conclusions: In terminally ill cancer patients, depression and anxiety as well its the interaction between HADS-Depression and opioids appeared to have a significant impact on the desire for hastened death while pain does not. Effective management of psychological symptoms seems to be an important aspect of adequate palliative care in order to reduce the desire tor hastened death. (c) 2005 Elsevier Inc. All rights reserved

The schedule of attitudes toward hastened death: validation analysis in terminally ill cancer patients.

OBJECTIVE: The faithful translation of the English version of the Schedule of Attitudes toward Hastened Death (SAHD) into Greek and its validation as an assessment tool in terminally ill cancer patients receiving palliative treatment. METHODS: 120 terminally ill cancer patients attending a Palliative Care Unit, at the University of Athens, Greece, between June 2003 and November 2003 for palliative treatment. RESULTS: SAHD would be a useful instrument for measuring desire for hastened death with valid psychometric properties in a Greek cancer population. The SAHD demonstrated high reliability. Desire for hastened death was significantly associated with Hospital Anxiety and Depression Scale (HAD) depression (r = 0.607, p < 0.0005) and substantially correlated with HAD anxiety (r = 0.502, p < 0.0005). "Pain intensity" had a moderate correlation with SAHD scores (r = 0.28, p = 0.01) and SAHD scores correlated significantly with "pain interference in mood" (r = 0.38, p = 0.01) and in "enjoyment of life" (r = 0.34, p = 0.03). SAHD correlation with quality of life was statistically significant (r = -0.38, p < 0.01) as was health status (r = -0.36, p < 0.01). Patients with a Poor Performance Status (from Eastern Cooperative Oncology Group scale) correlated significantly with high scores in SAHD (p = 0.038). Factor analysis supported the unidimentionality of the measurement. SIGNIFICANCE OF RESULTS: SAHD could be a useful and valid instrument for measuring desire for hastened death in Greek terminally ill cancer patients