Patients with advanced cancer are often polysymptomatic. Different symptoms occur
with varying frequency, intensity, and impact. Despite the high prevalence of symptoms
in this population, reports of symptomatology in palliative outpatients have been
limited. We report the symptom distress in metastatic cancer patients attending an
outpatient palliative radiotherapy clinic. Patients referred for palliative radiotherapy
for symptom control to the Rapid Response Radiotherapy Program (RRRP) were asked to
rate symptom distress using the Edmonton Symptom Assessment Scale (ESAS) at the time
of initial consultation. Patient demographics, cancer history, disease status, and
analgesic consumption during the previous 24 hours were recorded. Between January
1999 and January 2002, 1,296 patients were seen at the RRRP and consented to participate
in the study. Mean symptom distress rates ranged from 1.41 to 5.04. Fatigue, poor
sense of well-being, pain, and poor appetite were the highest scored symptoms consecutively.
Patients with poorer performance status (KPS < or = 60) had significantly higher symptom
distress scores for all nine symptoms (P < 0.001). We conclude that the symptoms of
metastatic cancer, including pain, fatigue, depression, anxiety, drowsiness, poor
appetite, and sense of well-being, are common among patients attending outpatient
palliative clinics. Symptom assessment tools, such as the ESAS, allow for the identification
of symptoms and their severity. The appropriate regimen for management of pain and
symptoms in metastatic cancer patients can then be planned.