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A review of the literature on multiple symptoms, their predictors, and associated outcomes in patients with advanced cancer

Published online by Cambridge University Press:  25 February 2011

Stephanie Gilbertson-White*
Department of Physiological Nursing, University of California, San Francisco, California
Bradley E. Aouizerat
Department of Physiological Nursing, UCSF Institute for Human Genetics, University of California, San Francisco, California
Thierry Jahan
Department of Oncology and Hematology, School of Medicine, University of California, San Francisco, California
Christine Miaskowski
Department of Physiological Nursing, University of California, San Francisco, California
Address correspondence and reprint requests to: Stephanie Gilbertson–White, Department of Physiological Nursing, University of California, 2 Koret Way, Box 0610, San Francisco, CA 94143-0610. E-mail:



The findings from several studies suggest that palliative care patients with advanced cancer experience multiple symptoms, and that these symptoms may be related to demographic and clinical factors as well as to patient outcomes. However, no systematic review has summarized the findings from studies that assessed multiple symptoms, predictors, and outcomes in these patients. The purposes of this review, focused on palliative care patients with advanced cancer, are to: 1) describe the relationships among multiple symptoms; 2) describe the predictors of multiple symptoms; and 3) describe the relationships between multiple symptoms and patient outcomes.


Comprehensive literature searches were completed using the following databases: PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsychInfo. The key words: cancer or advanced cancer or neoplasm, AND palliative care or terminal care or hospice or end-of-life, AND symptoms or multiple symptoms or symptom clusters were combined.


Twenty-two studies met the inclusion criteria and examined at least one of our purposes. The majority of these studies were descriptive and used one of four common symptom assessment scales. Fifty-six different signs and symptoms were evaluated across various dimensions (i.e., prevalence, severity, distress, frequency, control). Pain, dyspnea, and nausea were the only symptoms measured in all 22 studies. Relationships among concurrent symptoms were examined in nine studies. Relationships among symptoms and predictors (i.e., demographics, cancer type, healthcare delivery environment) were examined in seven studies. Relationships among symptoms and outcomes (i.e., functional status, psychological status, quality-of-life, survival time) were examined in 14 studies. Significant methodological variation was found among these studies.

Significance of results:

It is difficult to draw conclusions about the relationships among multiple symptoms, predictors, and outcomes due to the heterogeneity of these studies. Future research is needed to determine which symptoms and symptom dimensions to assess in order to better understand how multiple symptoms relate to each other as well to as predictors and outcomes in palliative care patients with advanced cancer.

Review Article
Copyright © Cambridge University Press 2011

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