Is Your Patient Reporting Many Somatic Symptoms? Are They Sad?

Patients with cancer who experience pain or depression also have a high rate of physical symptoms, such as fatigue, dry mouth and nausea, according to a report in the October 11 issue of Archives of Internal Medicine.

The article reports that having many physical, or somatic, symptoms is known to adversely affect patients in primary care settings and those with chronic medical conditions other than cancer.

“Somatic symptoms account for more than half of all general medical visits, lack a definitive medical explanation one-third to half of the time and are frequently persistent," write the authors. “Physical and psychological factors seem to contribute to somatic symptom reporting, even in patients with chronic medical disorders. These symptoms are associated with substantial functional impairment, disability and health care use, even after controlling for medical and psychiatric comorbidity.”

The research team included Kurt Kroenke, M.D., of the Richard Roudebush VA Medical Center, Indiana University, and Regenstrief Institute Inc., Indianapolis, and colleagues.

The team analyzed data from 405 patients with cancer who also had either pain or depression. Participants reported the presence and burden of 22 different somatic symptoms, along with the number of days of disability within the previous three-month period and health care use.

All patients in the study had at least one somatic symptom. More than half of the patients reported 15 of the 22 symptoms. The data indicated that the most common symptom was feeling tired with 97.5 % of the patients reporting this symptom. Having difficulty sleeping was the second most common with 78.8% experiencing this symptom. Pain in the limbs or joints was reported by78 %, back pain by 74.8%, and difficulty with memory by 72.1%.

Participants reported an average of 16.9 disability days in the previous four weeks, including 5.7 days in bed and 11.2 days when they reduced their activities by 50% or more. Health care usage was high as well: 32% of patients reported three to five outpatient visits in the previous three months, 28% reported six to 10 visits and 26% reported more than 10 visits. More than one-third (38%) were hospitalized at least once and one-third visited the emergency department one or more times.

On a scale of zero to 44, with 44 being the worst, participants had an average somatic symptom burden score of 18.3. A higher score was associated with education, employment status, income and an emergency department or mental health visit in the previous three months but not with sex, race or marital status. For every five-unit increase in somatic symptom burden score, the probability of having at least 14 days of disability in the previous 28 days increased by 50%.

Source: Jama & Archives

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Do the results of the study seem to be in line with your experience?