Multidimensional Problems Among Advanced Cancer Patients in Cuba: Awareness of Diagnosis Is Associated with Better Patient Status

Cancer is one of the major causes of death in Cuba, and in current practice, patients are not usually informed of their diagnosis. Palliativecare is an emerging discipline in this country. Cuban cancer patients with advanced disease completed the Palliative Outcome Scale (POS), and the researcher elicited patients knowledge of their condition and prognosis. The POS consits of 12 items that address the clinical, psychosocial,spiritual, family, and service delivery elements considered relevant to patients with advance disease.Ten items are scored 0 (no problem) to 4 (worst problem), with one open-response question about the main problems experienced and one question about whether the questionnaie was completed with help or alone. Mann-Whitney tests were used to compare POS item scores by patient awareness. Of the 91 patients who participated in the study, 41% knew they had cancer and 9% were belived to be aware that they were dying. The most burdensome problems recoded on the POS were wasted time on appointments (70% of patients scored 3 or 4), pain (42%), patient anxiety (39%), and family anxiety (37%). Those patients who were aware of their diagnosis had statistically significantly better scores with respect to symptoms. patient anxiety, receiving information, and receiving support from family and friends. This study adds to knowledge about characteristics of terminal cancer patients in Cuba and the factors contributing to patient burden. It is the first study to explore the palliative care needs of Cuban patients with advanced cancer. An association has been demonsrated between patient knowledge and quality of life in Cuba, a setting where disclosure is contrary to current clinical practice. J Pain Symptom Manage. 2009; 37 : 325-330. (C) 2009 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.