Severity of Symptoms as an Independent Predictor of Poor Outcomes in Patients with Advanced Cancer Presenting to the Emergency Department: Secondary Analysis of a Prospective Randomized Study
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Background/Objectives: Patients with advanced cancer often present to the emergency department (ED) with pain and distressing symptoms that are not systematically evaluated. The current study investigated the association of symptom severity with the diagnosis of delirium and short-term survival. Methods: In this secondary analysis of a prospective randomized study of delirium among advanced cancer patients in the ED, in which symptoms were assessed by the MD Anderson Symptom Inventory (MDASI), we analyzed the distribution of MDASI item scores by 90-day mortality (Kolmogorov–Smirnov), the association of MDASI item scores with short-term mortality (logistic regression models), and the symptoms in those with or without delirium (Mann–Whitney U test or chi-square test). Results: Of the 243 patients included, 222 (91.4%) had complete MDASI scores. The MDASI median symptom scores for pain, fatigue, and interference with work were the highest. A significant difference in MDASI item score distribution with 90-day mortality was observed for fatigue (p = 0.018), shortness of breath (p < 0.001), difficulty remembering (p = 0.038), lack of appetite (p = 0.035), drowsiness (p < 0.001), feeling sad (p = 0.031), and interference with walking (p < 0.001). In multivariable logistic regression models, shortness of breath (adjusted OR 1.15, 95% CI 1.04–1.26, p = 0.005) and drowsiness (adjusted OR 1.17, 95% CI 1.05–1.33, p = 0.008) were associated with 90-day mortality, adjusting for age, race, performance status, and cancer type. The median total MDASI score was significantly higher in patients with delirium than in those without (88, IQR 83–118 vs. 80, IQR 55–104; p < 0.001). Conclusions: Patients with advanced cancer presenting to the ED had severe symptoms, some of which were associated with shorter survival. These findings underscore the necessity of systematic symptom assessment, focusing on shortness of breath, drowsiness, fatigue, difficulty remembering, lack of appetite, feeling sad, and feeling distressed, to enhance clinical decision-making and improve the care of patients with advanced cancer. Additional longitudinal studies are needed to evaluate the improvement in symptoms and quality of life for these patients.
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High caregiver distress is associated with poorer quality of care, greater unplanned health care use, and higher caregiver symptom burden.
“High caregiver distress is associated with poorer quality of care, 16 greater unplanned health care use, 114 , 115 and higher caregiver symptom burden. 116”
From Nonpharmacologic interventions for managing distress, anxiety, and depression for patients with cancer and their family caregivers: A systematic review and meta‐analysis (2026) · cites this paper as [115]
The citation appears to support the clause about greater unplanned health care use. The Introduction discusses ED visits and hospitalization among patients with advanced cancer, but does not link that use to caregiver distress. A search for caregiver distress and health care use found no passage establishing the claimed association. (LLM, conf=0.76)
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FERRELL, B. R., Temel, J. S., Temin, S., Alesi, E. R., Balboni, T. A., Basch, E., Firn, J. I., Paice, J. A., Peppercorn, J. M., Phillips, T., et al. (2017) · Journal of Clinical Oncology · doi:10.1200/jco.2016.70.1474 · Cited by 2,148 · see citing works
Serlin, R. C., Mendoza, T. R., Nakamura, Y., Edwards, K. R., & Cleeland, C. S. (1995) · Pain · doi:10.1016/0304-3959(94)00178-h · Cited by 1,493 · see citing works
Association Between Palliative Care and Patient and Caregiver Outcomes
Kavalieratos, D., Corbelli, J. A., Zhang, D., Dionne-Odom, J. N., Ernecoff, N. C., Hanmer, J., Hoydich, Z., Ikejiani, D. Z., Klein‐Fedyshin, M., Zimmermann, C., et al. (2016) · JAMA · doi:10.1001/jama.2016.16840 · Cited by 1,183 · see citing works
Physical and psychological long-term and late effects of cancer
Stein, K., Syrjala, K. L., & Andrykowski, M. A. (2008) · Cancer · doi:10.1002/cncr.23448 · Cited by 772 · see citing works
Chemotherapy Use, Performance Status, and Quality of Life at the End of Life
Prigerson, H. G., Bao, Y., Shah, M. A., Paulk, M. E., LeBlanc, T. W., Schneider, B. J., Garrido, M. M., Reid, M. C., Berlin, D., Adelson, K. B., et al. (2015) · JAMA Oncology · doi:10.1001/jamaoncol.2015.2378 · Cited by 648 · see citing works
Availability and Integration of Palliative Care at US Cancer Centers
Hui, D. (2010) · JAMA · doi:10.1001/jama.2010.258 · Cited by 495 · see citing works
NCCN Practice Guidelines for Cancer-Related Fatigue.
Mock, V., Atkinson, A., Barsevick, A. M., Cella, D. F., Cimprich, B., Cleeland, C. S., Donnelly, J. P., Eisenberger, M. A., Escalante, C. P., Hinds, P. S., et al. (2000) · PubMed · Cited by 480 · see citing works
Lundström, M., Edlund, A., Karlsson, S., Brännström, B., Bucht, G., & Gustafson, Y. (2005) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2005.53210.x · Cited by 387 · see citing works
Reilly, C. M., Bruner, D. W., Mitchell, S. A., Minasian, L. M., Basch, E., Dueck, A. C., Cella, D. F., & Reeve, B. B. (2013) · Supportive Care in Cancer · doi:10.1007/s00520-012-1688-0 · Cited by 301 · see citing works
Bruera, E. D., Bush, S. H., Willey, J. S., Paraskevopoulos, T., Li, Z., Palmer, J. L., Cohen, M. Z., Sivesind, D., & Elsayem, A. F. (2009) · Cancer · doi:10.1002/cncr.24215 · Cited by 274 · see citing works
Self-citationBajwah, S., Oluyase, A. O., Yi, D., Gao, W., Evans, C., Grande, G., Todd, C. J., Costantini, M., Murtagh, F. E., & Higginson, I. J. (2020) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012780.pub2 · Cited by 237 · see citing works
Trends in Adult Cancer–Related Emergency Department Utilization
Rivera, D. R. R., Gallicchio, L. M., Brown, J., Liu, B., Kyriacou, D. N., & Shelburne, N. (2017) · JAMA Oncology · doi:10.1001/jamaoncol.2017.2450 · Cited by 235 · see citing works
Prophylactic action of oral fluconazole against fungal infection in neutropenic patients
Kanda, Y., Yamamoto, R., Chizuka, A., Hamaki, T., Suguro, M., Arai, C., Matsuyama, T., Takezako, N., Miwa, A., Kern, W., et al. (2000) · Cancer · doi:10.1002/1097-0142(20001001)89:7 · Cited by 151 · see citing works
A Multifactorial Intervention to Reduce Prevalence of Delirium and Shorten Hospital Length of Stay
Naughton, B. J., Saltzman, S., Ramadan, F. H., Chadha, N., Priore, R. L., & Mylotte, J. M. (2004) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2005.53005.x · Cited by 133 · see citing works
Grudzen, C. R., Richardson, L. D., Hopper, S. S., Ortiz, J. M., Whang, C., & Morrison, R. S. (2011) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2011.03.022 · Cited by 130 · see citing works
Wang, X. S., Fairclough, D. L., Liao, Z. X., Komaki, R. R., Chang, J. Y., Mobley, G. M., & Cleeland, C. S. (2006) · Journal of Clinical Oncology · doi:10.1200/jco.2006.07.1126 · Cited by 123 · see citing works
Performance status of patients is the major prognostic factor at all stages of pancreatic cancer
Taş, F., Şen, F., Odabaş, H., Kılıç, L., Keskın, S., & Yıldız, İ. (2012) · International Journal of Clinical Oncology · doi:10.1007/s10147-012-0474-9 · Cited by 121 · see citing works
Analysis of prognosis and disease progression after local recurrence of melanoma
Dong, X. D., Tyler, D. S., Johnson, J. L., DeMatos, P., & Seigler, H. F. (2000) · Cancer · doi:10.1002/(sici)1097-0142(20000301)88:5 · Cited by 111 · see citing works
Barbera, L. C., Sutradhar, R., Seow, H. Y., Earle, C. C., Howell, D., Mittmann, N., Li, Q., & Thiruchelvam, D. (2020) · JCO Oncology Practice · doi:10.1200/jop.19.00660 · Cited by 94 · see citing works
Lamba, S., DeSandre, P. L., Todd, K. H., Bryant, E., Chan, G. K., Grudzen, C. R., Weissman, D. E., & Quest, T. E. (2013) · Journal of Emergency Medicine · doi:10.1016/j.jemermed.2013.08.087 · Cited by 92 · see citing works
National characteristics of Emergency Department visits by patients with cancer in the United States
Hsu, J., Donnelly, J. P., Moore, J. X., Meneses, K., Williams, G. R., & Wang, H. E. (2018) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2018.03.025 · Cited by 87 · see citing works
Verhoef, M., de Nijs, E., Horeweg, N., Fogteloo, J., Heringhaus, C., Jochems, A., Fiocco, M. F., & van der Linden, Y. M. (2019) · Supportive Care in Cancer · doi:10.1007/s00520-019-04906-x · Cited by 85 · see citing works
A Clinical Update on Delirium: From Early Recognition to Effective Management
Cerejeira, J., & Mukaetova‐Ladinska, E. B. (2011) · Nursing Research and Practice · doi:10.1155/2011/875196 · Cited by 83 · see citing works
Lizán, L., Pérez–Carbonell, L., & Comellas, M. (2021) · Cancers · doi:10.3390/cancers13184615 · Cited by 76 · see citing works
Past, present, and future of palliative care in emergency medicine in the USA
George, N. R., Bowman, J. K., Aaronson, E. L., & Ouchi, K. (2020) · Acute Medicine & Surgery · doi:10.1002/ams2.497 · Cited by 64 · see citing works
Mendoza, T. R., Kehl, K. L., Bamidele, O. O., Williams, L. A., Shi, Q., Cleeland, C. S., & Simon, G. R. (2019) · Supportive Care in Cancer · doi:10.1007/s00520-018-4632-0 · Cited by 59 · see citing works
Validation of the M. D. Anderson Symptom Inventory multiple myeloma module
Jones, D., Vichaya, E. G., Wang, X. S., Williams, L. A., Shah, N., Thomas, S. K., Johnson, V. E., Champlin, R. E., Cleeland, C. S., & Mendoza, T. R. (2013) · Journal of Hematology & Oncology · doi:10.1186/1756-8722-6-13 · Cited by 56 · see citing works
Shortness of Breath and Cough in Patients in Palliative Care
Bausewein, C., & Simon, S. T. (2013) · Deutsches Ärzteblatt international · doi:10.3238/arztebl.2013.0563 · Cited by 53 · see citing works
Understanding cognition in older patients with cancer
Karuturi, M. S., Wong, M. L., Hsu, T., Kimmick, G. G., Lichtman, S. M., Holmes, H. M., Inouye, S. K., Dale, W., Loh, K. P., Whitehead, M., et al. (2016) · Journal of Geriatric Oncology · doi:10.1016/j.jgo.2016.04.004 · Cited by 53 · see citing works
Ma, Z., Li, H., Zhang, Y., Zhang, L., Huang, G. C., Zhang, Y., Shi, L., Liu, W., An, Z., & Guan, X. (2024) · EClinicalMedicine · doi:10.1016/j.eclinm.2024.102561 · Cited by 51 · see citing works
Mendoza, T. R., Zhao, F., Cleeland, C. S., Wagner, L. I., Patrick‐Miller, L. J., & Fisch, M. J. (2013) · Clinical Breast Cancer · doi:10.1016/j.clbc.2013.02.014 · Cited by 50 · see citing works
Comprehensive approaches to managing delirium in patients with advanced cancer
Kang, J. H., Shin, S. H., & Bruera, E. D. (2012) · Cancer Treatment Reviews · doi:10.1016/j.ctrv.2012.08.001 · Cited by 44 · see citing works
Delgado-Guay, M. O., Rodríguez-Núñez, A., Shin, S. H., Chisholm, G. B., Williams, J. L., Frisbee‐Hume, S. E., & Bruera, E. D. (2015) · Supportive Care in Cancer · doi:10.1007/s00520-015-3034-9 · Cited by 43 · see citing works
Delirium and Delirium Prevention in the Emergency Department
Lee, S., Howard, M. A., & Han, J. H. (2023) · Clinics in Geriatric Medicine · doi:10.1016/j.cger.2023.05.006 · Cited by 41 · see citing works
Elsayem, A. F., Bruera, E. D., Valentine, A. D., Warneke, C. L., Yeung, S. J., Page, V. D., Wood, G. L., Silvestre, J., Holmes, H. M., Brock, P. A., et al. (2016) · Cancer · doi:10.1002/cncr.30133 · Cited by 41 · see citing works
Self-citationHarris, D. (2007) · Postgraduate Medical Journal · doi:10.1136/pgmj.2006.052431 · Cited by 40 · see citing works
Emergency Department Use by Terminally Ill Patients: A Systematic Review
Amado, J., Oscanoa, T. J., Vásquez-Alva, R., Huari-Pastrana, R., & Delgado-Guay, M. O. (2020) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2020.08.009 · Cited by 39 · see citing works
Effect of a Symptom Monitoring Intervention for Patients Hospitalized With Advanced Cancer
Nipp, R. D., Horick, N., Qian, C. L., Knight, H. P., Kaslow-Zieve, E. R., Azoba, C. C., Elyze, M., Landay, S. L., Kay, P. S., Ryan, D. P., et al. (2022) · JAMA Oncology · doi:10.1001/jamaoncol.2021.7643 · Cited by 38 · see citing works
The relationship between dyspnea and patient satisfaction with quality of life in advanced cancer
Gupta, D., Lis, C. G., & Grutsch, J. F. (2006) · Supportive Care in Cancer · doi:10.1007/s00520-006-0178-7 · Cited by 34 · see citing works
Elsayem, A. F., Merriman, K. W., Gonzalez, C. E., Yeung, S. J., Chaftari, P. S., Reyes‐Gibby, C. C., & Todd, K. H. (2016) · Journal of Oncology Practice · doi:10.1200/jop.2015.009019 · Cited by 34 · see citing works
Self-citationKutzko, J. H., Dadwal, P., Holt, T., Rahman, M. A., Zahir, S. F., & Hickey, B. E. (2022) · Radiotherapy and Oncology · doi:10.1016/j.radonc.2022.01.030 · Cited by 29 · see citing works
Majzoub, I. E., Qdaisat, A. Z., Chaftari, P. S., Yeung, S. J., Sawaya, R. D., Jizzini, M., Carreras, M. T. C., Abunafeesa, H., & Elsayem, A. F. (2018) · Supportive Care in Cancer · doi:10.1007/s00520-018-4554-x · Cited by 29 · see citing works
Self-citationDelgado-Guay, M. O., Yennurajalingam, S., & Bruera, E. D. (2008) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2007.11.004 · Cited by 27 · see citing works
Increased Symptom Expression among Patients with Delirium Admitted to an Acute Palliative Care Unit
de la Cruz, M., Yennurajalingam, S., Liu, D., Wu, J., Reddy, A. S., & Bruera, E. D. (2017) · Journal of Palliative Medicine · doi:10.1089/jpm.2016.0315 · Cited by 27 · see citing works
Elsayem, A. F., Bruera, E. D., Valentine, A. D., Warneke, C. L., Wood, G. L., Yeung, S. J., Page, V. D., Silvestre, J., Brock, P. A., & Todd, K. H. (2017) · The Oncologist · doi:10.1634/theoncologist.2017-0115 · Cited by 22 · see citing works
Self-citationWang, X. S., Shi, Q., Williams, L. A., Cleeland, C. S., García-González, A., Chen, T.-Y., Shahid, D. R., Ramirez, P. T., Iniesta, M. D., Siverand, A. M., et al. (2019) · Gynecologic Oncology · doi:10.1016/j.ygyno.2018.11.004 · Cited by 21 · see citing works
Mendoza, T. R., Sheshadri, A., Altan, M., Hess, K. R., George, G. C., Stephen, B., Castillo, L., Rodriguez, E., Gong, J., Peterson, C. B., et al. (2020) · Journal for ImmunoTherapy of Cancer · doi:10.1136/jitc-2020-000931 · Cited by 20 · see citing works
The Diagnostic Sensitivity of the Memorial Delirium Assessment Scale—Spanish Version
Barahona, E., Pinhao, R., Galindo, V., & Noguera, A. (2017) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2017.11.013 · Cited by 20 · see citing works
Mercadante, S., Adile, C., Ferrera, P., Cortegiani, A., & Casuccio, A. (2018) · The Oncologist · doi:10.1634/theoncologist.2018-0244 · Cited by 17 · see citing works
Yilmaz, S., Grudzen, C. R., Durham, D. D., McNaughton, C., Marcelin, I., Abar, B. W., Adler, D., Bastani, A., Baugh, C. W., Bernstein, S. L., et al. (2022) · Journal of Palliative Medicine · doi:10.1089/jpm.2021.0567 · Cited by 16 · see citing works
Self-citationSymptom Burden in Patients With Reduced Performance Status at the Start of Palliative Radiotherapy
Nieder, C., & Kämpe, T. A. (2020) · In Vivo · doi:10.21873/invivo.11832 · Cited by 8 · see citing works
Ghabashi, E. H., Sharaf, B. M., Kalaktawi, W. A., Calacattawi, R. W., & Calacattawi, A. W. (2021) · Cureus · doi:10.7759/cureus.15313 · Cited by 7 · see citing works
Williams, L. A., Whisenant, M., Mendoza, T. R., Peek, A., Malveaux, D., Griffin, D., Ponce, D. A., Granwehr, B. P., Sheshadri, A., Hutcheson, K. A., et al. (2023) · Journal of Patient-Reported Outcomes · doi:10.1186/s41687-023-00591-x · Cited by 6 · see citing works
Oguz, G. T., Koçak, N., Şenel, G., & Kadıoğulları, N. (2021) · Indian Journal of Palliative Care · doi:10.4103/ijpc.ijpc_126_20 · Cited by 3 · see citing works
Elsayem, A. F., Warneke, C. L., Reyes‐Gibby, C. C., Buffardi, L. J., Sadaf, H., Chaftari, P. S., Brock, P. A., Page, V. D., Viets-Upchurch, J. M., Lipe, D. N., et al. (2022) · Journal of Emergency Medicine · doi:10.1016/j.jemermed.2022.05.014 · Cited by 2 · see citing works
Self-citationMajdinasab, E. J., & Puckett, Y. (2020) · ecancermedicalscience · doi:10.3332/ecancer.2020.1112 · Cited by 2 · see citing works
The rapid assessment of fatigue severity in cancer patients
Mendoza, T. R., Wang, X. S., Cleeland, C. S., Morrissey, M., Johnson, B. A., Wendt, J. K., & Huber, S. L. (1999) · Cancer · doi:10.1002/(sici)1097-0142(19990301)85:5 · Cited by 1 · see citing works
Emergency Department Management of Common End-of-Life and Palliative Care Symptoms: Three Cases
Chang, A., Espinosa, J. A., & Lucerna, A. (2024) · Cureus · doi:10.7759/cureus.53538 · Cited by 1 · see citing works
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Shao, R., Neil, J. M., Chen, M., Hannafon, B. N., Nipp, R. D., Montgomery, A., Frank-Pearce, S. G., Moxley, K. M., Richardson, D. L., Elliott, J., et al. (2026) · BMC Cancer · doi:10.1186/s12885-026-15772-2 · Cited by 2 · see citing works
Boland, J. W., & Boland, E. G. (2025) · Clinical Medicine · doi:10.1016/j.clinme.2025.100510 · Cited by 2 · see citing works
Schiess, L. C., Song, L. L., Schädelin, S., Fürst, T., Urech, C., Friese, C. R., & Katapodi, M. C. (2026) · CA: A Cancer Journal for Clinicians · doi:10.3322/caac.70076
- Authors
- Qdaisat, A., Stroh, E., Reyes-Gibby, C., Wattana, M. K., Viets-Upchurch, J., Li, Z., Page, V. D., Fatima, H., Chaftari, P., & Elsayem, A.
- Affiliations
- The University of Texas MD Anderson Cancer Center (US)
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Corresponding author
- Elsayem, Ahmed
- ORCID
- Venue
- Cancers
- Publisher
- MDPI AG
- Published
- 2024-11-28
- Volume
- 16
- Issue
- 23
- Pages
- 3988
- ISSN
- 2072-6694 (ISSN-L)
- PMC
- PMC11640218
- OpenAlex
- W4404828342
- Cited by
- 3
- References
- 58
- Citations by year
- 2026: 2 · 2025: 1
- FWCI
- 1.24
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Cancers (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Digital Commons-TMC (Texas Medical Center) (submittedVersion)
- Funders
- National Institutes of Health (P30CA016672)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Keywords
- advanced cancer, emergency department presentation, symptom severity, delirium, 90-day mortality, dyspnea, sleepiness, fatigue, MD Anderson Symptom Inventory, symptom assessment, prognostic factors, short-term survival, pain, appetite loss, performance status, cancer pain management, palliative care
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