Symptoms

Dyspnea is a subjective feeling of shortness of breath. Dyspnea may be observed, for instance in a person noticeably struggling to breath. However, it is primarily the patient’s subjective experience that the clinician must assess. A description of dyspnea may include: “I feel like I’m suffocating” or “my chest feels tight” or “I can’t seem to get enough air”.

Fatigue is a subjective feeling of loss of energy, tiredness or exhaustion. In some, it may be described as the most distressing symptom as well as the symptom that has the most negative impact on quality of life. Fatigue can be the result of multiple factors. It is associated with serious illnesses such as heart disease, cancer, and end stage organ failure, as well as electrolyte imbalances, malnutrition, and anemia. Fatigue is also associated with treatments for cancer such as radiation and chemotherapy. Fatigue can be caused by disruptions in sleep as well as anxiety, pain, stress, or depression.

Constipation is the decreased frequency or absence of bowel movements. Common causes include medications such as opiates and anticholinergic drugs; certain illnesses that can cause delayed emptying such as multiple sclerosis and Parkinson’s; chemical imbalances such as hypercalcemia and hypokalemia; or reduced oral intake and reduced activity.

Nausea and Vomiting Nausea is the subjective feeling that may or may not be accompanied by vomiting. Vomiting is the forceful contraction of the abdominal muscles, resulting in expulsion of stomach contents. Nausea and vomiting are common and often distressing side effects of cancer treatment. They are also seen in persons with constipation, obstipation, or impaction; electrolyte imbalances such as hypercalcemia or uremia; and increased intracranial pressure secondary to metastatic disease to the brain.

Anxiety is the subjective feeling of apprehension or uneasiness. Its causes can be physical distress, as in someone experiencing dyspnea; psychosocial distress, as in someone experiencing loss of income due to illness; emotional distress, which is often experienced in those with depression; and/or spiritual distress, as in someone questioning their spiritual beliefs due to serious illness.

Depression is an emotional state that can range between minor mood changes to a pathological inability to cope with life. It is not an uncommon experience of those faced with a life limiting serious illness. Depression can be situational as a response to diagnosis with serious illness, which is generally self-limited and responds well to education and support. Major depression on the other hand is a serious medical condition requiring both psychological and pharmacologic management.