Symptom masquerade: understanding the meaning of symptoms

Somatization refers to patients who transform distress and global suffering into pain and symptom expression. We have observed the opposite phenomenon in some outpatients seen for palliative care: patients who transform pain nociception into global suffering or other symptoms. The goal of this study is to describe the meaning of these patients' experiences that are not expressed as pain but seem to masquerade as other symptoms.

Hermeneutic phenomenological research methods guided this study with ten patients with advanced cancer. Interviews continued until data were saturated.

Results included that all patients described frustration that they had outlived their usefulness. All expressed an awareness that they were dying, some very directly with sadness but appreciation for the support they received from family and friends, some with anger, and some who were actively fighting death awareness because they were not "ready" to die. Patients described themselves as strong and healthy and reluctant to take medications, both because this was a new and unacceptable behavior for them, and because they were averse to the side effects.

In conclusion, careful evaluation of symptom experiences can ensure appropriate treatment. Patients with advanced cancer may not report pain even though pain medications often improve their other symptoms and well-being. Patients valued selection of medication that allowed them to remain alert and functional. The meaning of symptoms clearly altered patients' reports and limited treatments they found acceptable. Understanding these meanings is important to ensure that patients are treated in the most appropriate ways possible.