Frequency of side effects in outpatient cancer care and their influence on patient satisfaction - A prospective survey using the PASQOC® questionnaire

Study objectives: The aims of the study were to examine the frequency of side effects and fatigue in ambulatory cancer patients and to analyse how these symptoms are reflected in patient satisfaction. Setting: Private practices (N=41) and day hospitals (N=8) in Germany took part in the study. Participants: The respondents were 4,538 patients with cancer (response rate: 82%). The diagnoses were: 25% breast cancer, 21% colorectal cancer, 11% lymphomas and 12% haematological malignancies; mean age 63.5 years; 57% female. Measurements: The 2004 PASQOC® questionnaire contained 63 problem-oriented items which covered patient satisfaction for 15 dimensions of care. One item specifically assessed the prevalence of 17 different side effects. A score reflecting the severity of fatigue (fatigue index) was computed from three additional questions. For statistical analysis of patient satisfaction, the problem frequency was computed for each item. Results: The most frequent single side effects were fatigue (60%), hair loss (54%), nausea (51%), sleep disturbance (42%), weight loss (36%), diarrhoea (32%) and mouth ulcerations (31%). The mean number of side effects was 5 per patient (range 0 to 17). The fatigue index revealed that 42% of subjects complained of moderate and 28% of severe fatigue. Both the total number of side effects and the fatigue score were negatively associated with patient satisfaction. Conclusions: Side effects and especially fatigue are frequent problems in cancer patients and are related to the patients' assessment of cancer care. Routine symptom assessment may identify patients who require more comprehensive supportive care.