Kirkova et al identified risk factors for distress in a patient with advanced cancer. These can help to identify a patient who may benefit from interventions to reduce the distress. The authors are from the Cleveland Clinic Taussig Cancer Institute.


Patient selection: advanced cancer (presumably metastatic in need of palliative care)


Risk factors for distress:

(1) age <= 65 years of age

(2) female gender

(3) poor performance status (ECOG 3 or 4 > ECOG 2 > ECOG 1)

(4) greater symptom severity

(5) poor coping skills


Some symptoms may be distressful for a patient even if mild, so symptom severity is not the sole predictor. Incontinence, fever and visual disturbances tend to be distressful even when mild or moderate (Table 2). Past history of distress might be a clue.


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