High Symptom Burden and Low Functional Status in the Setting of Multimorbidity

Abstract

Objectives: To enhance understanding of the relationship between multimorbidity, symptom burden, and functional status in individuals with life-limiting illness.

Design: Secondary analysis of baseline data from a randomized clinical trial conducted in the Palliative Care Research Cooperative Group. Group differences were tested using a t-test; multivariate regression analysis was used to determine the effect of multiple variables on functional status and symptom burden.

Setting: Fifteen Palliative Care Research Cooperation sites.

Participants: Adults who participated in a parent statin-discontinuation clinical trial were included in the analysis (N = 381). Inclusion criteria were diagnosis of a life-limiting illness, statin use for 3 months or longer, life expectancy longer than 1 month, and declining functional status.

Measurements: Cancer diagnosis (solid organ and hematologic malignancies), multimorbidity (Charlson Comorbidity Index (CCI) score), symptom burden (Edmonton Symptom Assessment Scale (ESAS) score, number of symptoms with ESAS severity score >4), functional status (Australia-modified Karnofsky Performance Scale (AKPS)).

Results: Fifty-one percent had a primary diagnosis of cancer; mean age 74.1 ± 11.6. Participants had multiple comorbid illnesses (CCI score 4.9 ± 2.8), multiple symptoms (ESAS score 27.2 ± 15.9), and poor functional status (AKPS = 53 ± 13). In univariate and multivariate analyses, multimorbidity was associated with greater symptom burden (4.2 vs 3.1 moderate or severe symptoms (t = -3.2, P = .002), 12% vs 6% with severe symptoms (t = -3.7, P < .001)), but cancer diagnosis was not. In univariate and multivariate analyses, higher symptom burden was associated with poorer functional status (F = 11.6, P < .001), but multimorbidity was not.

Conclusion: Symptoms cannot be attributed solely to a diagnosis of cancer. The association between symptom burden and functional status underscores the importance of clinical attention to symptoms in individuals with multimorbidity.

Keywords: functional status; multimorbidity; symptom burden.

Conflict of interest statement

Conflict of Interests

Jennifer Dickman Portz has no financial or personal conflicts to disclose.

Jean S. Kutner has no financial or personal conflicts to disclose.

Patrick J. Blatchford has no financial or personal conflicts to disclose.

Christine L. Ritchie has no financial or personal conflicts to disclose.

The authors have no conflicts in the cover letter as well as in the manuscript, as noted above

© 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.