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Rojas-Concha L, Hansen MB, Petersen MA, Groenvold M. Symptoms of advanced cancer in palliative medicine: a longitudinal study. BMJ Support Palliat Care 2023; 13:e415-e427. [PMID: 34162585 DOI: 10.1136/bmjspcare-2021-002999] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 06/05/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES This study aimed to examine the symptomatology of patients with advanced cancer at admittance to palliative care services and to investigate how the symptomatology changed during the first month, and whether these changes were associated with various patient characteristics. METHODS In a longitudinal study in Chile, outpatients with advanced cancer completed the questionnaires European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care and the Hospital Anxiety and Depression Scale. Prevalence and severity of symptoms and problems (S/Ps) at baseline were calculated. Differences in S/P scores from baseline to follow-up were calculated overall and according to patient characteristics. Multiple linear regression was used to study the associations between patient characteristics and changes in S/P scores. RESULTS At baseline, 201 patients answered the questionnaires and 177 completed the follow-up. Fatigue, pain and sleeping difficulties were the most prevalent S/Ps reported, and also had the highest mean scores at baseline. S/P scores at baseline varied significantly according to sex, age, civil status, residence, children, prior and current antineoplastic treatment. Emotional functioning, pain, sleeping difficulties, constipation and anxiety improved significantly during the first month of palliative care. Residence, cohabitation status, diagnosis and current antineoplastic treatment were associated with changes in S/P scores. CONCLUSIONS Patients reported moderate-to-severe levels of S/Ps at admittance to palliative care. Several S/Ps improved the first month. Certain patient characteristics were associated with changes in S/P scores. This information may guide clinicians to more effective interventions that can improve the quality of life of patients receiving palliative care.
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Affiliation(s)
- Leslye Rojas-Concha
- Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Maiken Bang Hansen
- Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Morten Aagaard Petersen
- Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mogens Groenvold
- Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Battat M, Omair N, WildAli MA, Alkaissi A, Salameh HT, Amer R, Koni AA, Zyoud SH. Factors associated with palliative care symptoms in cancer patients in Palestine. Sci Rep 2023; 13:16190. [PMID: 37758820 PMCID: PMC10533841 DOI: 10.1038/s41598-023-43469-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 09/24/2023] [Indexed: 09/29/2023] Open
Abstract
Palliative care is critical to redundancy in cancer patients seeking to improve their quality of life. Evaluation should be incorporated into clinical practice routines at all stages of cancer. The Edmonton Symptom Assessment System (ESAS) was used to rate the intensity of ten symptom evaluations designed and validated for cancer patients in various languages and cultures. Therefore, the study aims to assess the symptoms reported using ESAS scores to identify patients who would benefit from palliative care that can improve the integration of palliative care into standard cancer care at An-Najah National University Hospital (NNUH). A cross-sectional study was selected for 271 cancer patients using a convenience sampling method at NNUH. Demographic, clinical, and lifestyle characteristics are described. Furthermore, patients' moderate to severe symptoms (score > 4) were obtained using ESAS-R. The survey consisted of 271 patients, with a response rate of 95%. The average age of the patients was 47 ± 17.7 years, ranging from 18 to 84 years. The male-to-female ratio was approximately 1:1, 59.4% of the patients were outpatients, and 153 (56.5%) had hematologic malignancies. Fatigue (62.7%) and drowsiness (61.6%) were the most common moderate to severe symptoms in ESAS. Furthermore, pain (54.6%), nausea (40.2%), lack of appetite (55.0%), shortness of breath (28.5%), depression (40.6%), anxiety (47.2%) and poor well-being (56.5%) were reported. In conclusion, fatigue and drowsiness were the most reported symptoms according to the ESAS scale among cancer patients, while moderate to severe symptoms were reported in cancer patients using the ESAS. The ESAS is a functional tool for assessing cancer patients' symptoms and establishing palliative care services.
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Affiliation(s)
- Maher Battat
- Bone Marrow Transplant and Leukemia Unit, An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Nawal Omair
- Department of Hematology and Oncology, An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Mohammad A WildAli
- Department of Hematology and Oncology, An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Aidah Alkaissi
- Department of Nursing, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
| | - Husam T Salameh
- Department of Hematology and Oncology, An-Najah National University Hospital, Nablus, 44839, Palestine.
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
| | - Riad Amer
- Department of Hematology and Oncology, An-Najah National University Hospital, Nablus, 44839, Palestine
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
| | - Amer A Koni
- Division of Clinical Pharmacy, Department of Hematology and Oncology, An-Najah National University Hospital, Nablus, 44839, Palestine
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
| | - Sa'ed H Zyoud
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
- Poison Control and Drug Information Center (PCDIC), College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
- Clinical Research Center, An-Najah National University Hospital, Nablus, 44839, Palestine.
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Hansen MB, Adsersen M, Rojas-Concha L, Petersen MA, Ross L, Groenvold M. Nausea at the start of specialized palliative care and change in nausea after the first weeks of palliative care were associated with cancer site, gender, and type of palliative care service-a nationwide study. Support Care Cancer 2022; 30:9471-9482. [PMID: 35960379 DOI: 10.1007/s00520-022-07310-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/01/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE Nausea is a common and distressful symptom among patients in palliative care, but little is known about possible socio-demographic and clinical patient characteristics associated with nausea at the start of palliative care and change after initiation of palliative care. The aim of this study was to investigate whether patient characteristics were associated with nausea at the start of palliative care and with change in nausea during the first weeks of palliative care, respectively. METHODS Data was obtained from the nationwide Danish Palliative Care Database. The study included adult cancer patients who were admitted to palliative care and died between June 2016 and December 2020 and reported nausea level at the start of palliative care and possibly 1-4 weeks later. The associations between patient characteristics and nausea at the start of palliative care and change in nausea during palliative care, respectively, were studied using multiple regression analyses. RESULTS Nausea level was reported at the start of palliative care by 23,751 patients of whom 8037 also reported 1-4 weeks later. Higher nausea levels were found for women, patients with stomach or ovarian cancer, and inpatients at the start of palliative care. In multivariate analyses, cancer site was the variable most strongly associated with nausea change; the smallest nausea reductions were seen for myelomatosis and no reduction was seen for stomach cancer. CONCLUSION This study identified subgroups with the highest initial nausea level and those with the least nausea reduction after 1-4 weeks of palliative care. These latter findings should be considered in the initial treatment plan.
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Affiliation(s)
- Maiken Bang Hansen
- Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine GP, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, NV, DK-2400, Copenhagen, Denmark.
| | - Mathilde Adsersen
- Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine GP, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, NV, DK-2400, Copenhagen, Denmark
| | - Leslye Rojas-Concha
- Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine GP, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, NV, DK-2400, Copenhagen, Denmark
| | - Morten Aagaard Petersen
- Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine GP, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, NV, DK-2400, Copenhagen, Denmark
| | - Lone Ross
- Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine GP, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, NV, DK-2400, Copenhagen, Denmark
| | - Mogens Groenvold
- Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine GP, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, NV, DK-2400, Copenhagen, Denmark.,Department of Public Health, University of Copenhagen, DK-1353, Copenhagen, Denmark
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Turner K, Brownstein NC, Thompson Z, Naqa IE, Luo Y, Jim HS, Rollison DE, Howard R, Zeng D, Rosenberg SA, Perez B, Saltos A, Oswald LB, Gonzalez BD, Islam JY, Tabriz AA, Zhang W, Dilling TJ. Longitudinal patient-reported outcomes and survival among early-stage non-small cell lung cancer patients receiving stereotactic body radiotherapy. Radiother Oncol 2022; 167:116-121. [PMID: 34953934 PMCID: PMC8934278 DOI: 10.1016/j.radonc.2021.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/07/2021] [Accepted: 12/15/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND PURPOSE The study objective was to determine whether longitudinal changes in patient-reported outcomes (PROs) were associated with survival among early-stage, non-small cell lung cancer (NSCLC) patients undergoing stereotactic body radiation therapy (SBRT). MATERIALS AND METHODS Data were obtained from January 2015 through March 2020. We ran a joint probability model to assess the relationship between time-to-death, and longitudinal PRO measurements. PROs were measured through the Edmonton Symptom Assessment Scale (ESAS). We controlled for other covariates likely to affect symptom burden and survival including stage, tumor diameter, comorbidities, gender, race/ethnicity, relationship status, age, and smoking status. RESULTS The sample included 510 early-stage NSCLC patients undergoing SBRT. The median age was 73.8 (range: 46.3-94.6). The survival component of the joint model demonstrates that longitudinal changes in ESAS scores are significantly associated with worse survival (HR: 1.04; 95% CI: 1.02-1.05). This finding suggests a one-unit increase in ESAS score increased probability of death by 4%. Other factors significantly associated with worse survival included older age (HR: 1.04; 95% CI: 1.03-1.05), larger tumor diameter (HR: 1.21; 95% CI: 1.01-1.46), male gender (HR: 1.87; 95% CI: 1.36-2.57), and current smoking status (HR: 2.39; 95% CI: 1.25-4.56). CONCLUSION PROs are increasingly being collected as a part of routine care delivery to improve symptom management. Healthcare systems can integrate these data with other real-world data to predict patient outcomes, such as survival. Capturing longitudinal PROs-in addition to PROs at diagnosis-may add prognostic value for estimating survival among early-stage NSCLC patients undergoing SBRT.
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Affiliation(s)
- Kea Turner
- Department of Health Outcomes and Behavior, 12902 USF
Magnolia Drive, Moffitt Cancer Center, US
| | - Naomi C. Brownstein
- Department of Biostatistics and Bioinformatics, 12902 USF
Magnolia Drive, Moffitt Cancer Center, US
| | - Zachary Thompson
- Department of Biostatistics and Bioinformatics, 12902 USF
Magnolia Drive, Moffitt Cancer Center, US
| | - Issam El Naqa
- Department of Machine Learning, 12902 USF Magnolia Drive,
Moffitt Cancer Center, US
| | - Yi Luo
- Department of Machine Learning, 12902 USF Magnolia Drive,
Moffitt Cancer Center, US
| | - Heather S.L. Jim
- Department of Health Outcomes and Behavior, 12902 USF
Magnolia Drive, Moffitt Cancer Center, US
| | - Dana E. Rollison
- Department of Cancer Epidemiology, 12902 USF Magnolia
Drive, Moffitt Cancer Center, US
| | - Rachel Howard
- Department of Health Informatics, 12902 USF Magnolia
Drive, Moffitt Cancer Center, US
| | - Desmond Zeng
- Morsani College of Medicine, 12901 Bruce B. Downs
Boulevard, University of South Florida, US
| | - Stephen A. Rosenberg
- Department of Radiation Oncology, 12902 USF Magnolia
Drive, Moffitt Cancer Center, US,Department of Thoracic Oncology, 12902 USF Magnolia Drive,
Moffitt Cancer Center, US
| | - Bradford Perez
- Department of Radiation Oncology, 12902 USF Magnolia
Drive, Moffitt Cancer Center, US,Department of Thoracic Oncology, 12902 USF Magnolia Drive,
Moffitt Cancer Center, US
| | - Andreas Saltos
- Department of Thoracic Oncology, 12902 USF Magnolia Drive,
Moffitt Cancer Center, US
| | - Laura B. Oswald
- Department of Health Outcomes and Behavior, 12902 USF
Magnolia Drive, Moffitt Cancer Center, US
| | - Brian D. Gonzalez
- Department of Health Outcomes and Behavior, 12902 USF
Magnolia Drive, Moffitt Cancer Center, US
| | - Jessica Y. Islam
- Department of Cancer Epidemiology, 12902 USF Magnolia
Drive, Moffitt Cancer Center, US
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior, 12902 USF
Magnolia Drive, Moffitt Cancer Center, US
| | - Wenbin Zhang
- Department of Machine Learning, 500 Forbes Avenue, Gates
Hillman Center, Carnegie Mellon University, US
| | - Thomas J. Dilling
- Department of Radiation Oncology, 12902 USF Magnolia
Drive, Moffitt Cancer Center, US,Department of Thoracic Oncology, 12902 USF Magnolia Drive,
Moffitt Cancer Center, US
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5
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Shapiro GK, Mah K, de Vries F, Li M, Zimmermann C, Hales S, Rodin G. A cross-sectional gender-sensitive analysis of depressive symptoms in patients with advanced cancer. Palliat Med 2020; 34:1436-1446. [PMID: 32781931 DOI: 10.1177/0269216320947961] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Patients with advanced cancer commonly report depressive symptoms. Examinations of gender differences in depressive symptoms in patients with advanced cancer have yielded inconsistent findings. AIM The objective of this study was to investigate whether the severity and correlates of depressive symptoms differ by gender in patients with advanced cancer. DESIGN Participants completed measures assessing sociodemographic and medical characteristics, disease burden, and psychosocial factors. Depressive symptoms were examined using the Patient Health Questionnaire, and other measures included physical functioning, symptom burden, general anxiety, death related distress, and dimensions of demoralization. A cross-sectional analysis examined the univariate and multivariate relationships between gender and depressive symptoms, while controlling for important covariates in multivariate analyses. SETTING/PARTICIPANTS Patients with advanced cancer (N = 305, 40% males and 60% females) were recruited for a psychotherapy trial from outpatient oncology clinics at a comprehensive cancer center in Canada. RESULTS Severity of depressive symptoms was similar for males (M = 7.09, SD = 4.59) and females (M = 7.66, SD = 5.01), t(303) = 1.01, p = 0.314. Greater general anxiety and number of cancer symptoms were associated with depressive symptoms in both males and females. Feeling like a failure (β = 0.192), less death anxiety (β = -0.188), severity of cancer symptoms (β = 0.166), and older age (β = 0.161) were associated with depressive symptoms only in males, while disheartenment (β = 0.216) and worse physical functioning (β = 0.275), were associated with depressive symptoms only in females. CONCLUSIONS Males and females report similar levels of depressive symptoms but the pathways to depression may differ by gender. These differences suggest the potential for gender-based preventive and therapeutic interventions in this population.
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Affiliation(s)
- Gilla K Shapiro
- Department of Supportive Care, Princess Margaret Cancer Centre (University Health Network), Toronto, ON, Canada.,Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), University of Toronto and Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Kenneth Mah
- Department of Supportive Care, Princess Margaret Cancer Centre (University Health Network), Toronto, ON, Canada
| | - Froukje de Vries
- Department of Supportive Care, Princess Margaret Cancer Centre (University Health Network), Toronto, ON, Canada
| | - Madeline Li
- Department of Supportive Care, Princess Margaret Cancer Centre (University Health Network), Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre (University Health Network), Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sarah Hales
- Department of Supportive Care, Princess Margaret Cancer Centre (University Health Network), Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre (University Health Network), Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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6
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Hertler C, Seiler A, Gramatzki D, Schettle M, Blum D. Sex-specific and gender-specific aspects in patient-reported outcomes. ESMO Open 2020; 5:e000837. [PMID: 33184099 PMCID: PMC7662538 DOI: 10.1136/esmoopen-2020-000837] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 09/22/2020] [Accepted: 10/07/2020] [Indexed: 01/10/2023] Open
Abstract
Patient-reported outcomes (PROs) are important tools in patient-centred medicine and allow for individual assessment of symptom burden and aspects of patients’ quality of life. While sex and gender differences have emerged in preclinical and clinical medicine, these differences are not adequately represented in the development and use of patient-reported outcome measures. However, even in personalised approaches, undesirable biases may occur when samples are unbalanced for certain characteristics, such as sex or gender. This review summarises the current status of the literature and trends in PROs with a focus on sex and gender aspects.
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Affiliation(s)
- Caroline Hertler
- Department of Radiation Oncology and Competence Center for Palliative Care, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
| | - Annina Seiler
- Department of Radiation Oncology and Competence Center for Palliative Care, University Hospital Zurich and University of Zurich, Zurich, Switzerland; Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Dorothee Gramatzki
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Markus Schettle
- Department of Radiation Oncology and Competence Center for Palliative Care, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - David Blum
- Department of Radiation Oncology and Competence Center for Palliative Care, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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7
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van Seventer EE, Fish MG, Fosbenner K, Kanter K, Mojtahed A, Allen JN, Blaszkowsky L, Clark JW, Dubois J, Franses JW, Giantonio BJ, Goyal L, Klempner SJ, Roeland EJ, Ryan DP, Weekes CD, Mulvey T, El-Jawahri A, Horick N, Corcoran RB, Parikh AR, Nipp RD. Associations of baseline patient-reported outcomes with treatment outcomes in advanced gastrointestinal cancer. Cancer 2020; 127:619-627. [PMID: 33170962 DOI: 10.1002/cncr.33315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Patient-reported outcomes (PROs) assessing quality of life (QOL) and symptom burden correlate with clinical outcomes in patients with cancer. However, to the authors' knowledge, data regarding associations between PROs and treatment response are lacking. METHODS The authors prospectively approached consecutive patients with advanced gastrointestinal cancer who were initiating a new treatment. Prior to treatment, patients reported their QOL (Functional Assessment of Cancer Therapy-General [FACT-G], 4 subscales: Functional, Physical, Emotional, Social; higher scores indicate better QOL) and symptom burden (Edmonton Symptom Assessment System [ESAS], Patient Health Questionnaire-4 [PHQ-4]; higher scores represent greater symptoms). Regression models were used to examine associations of baseline PROs with treatment response (clinical benefit or progressive disease [PD] at time of first scan), healthcare utilization, and survival. RESULTS From May 2019 to April 2020, a total of 112 patients with advanced gastrointestinal cancer were enrolled. For treatment response, 64.3% had CB and 35.7% had PD. Higher baseline ESAS-Physical (odds ratio, 1.04; P = .027) and lower FACT-G Functional (odds ratio, 0.92; P = .038) scores were associated with PD. Higher ESAS-Physical (hazard ratio [HR], 1.03; P = .044) and lower FACT-G Total (HR, 0.96; P = .005), FACT-G Physical (HR, 0.89; P < .001), and FACT-G Functional (HR, 0.87; P < .001) scores were associated with a greater hospitalization risk. Lower FACT-G Total (HR, 0.96; P = .009) and FACT-G Emotional (HR, 0.86; P = .012) scores as well as higher ESAS-Total (HR, 1.03; P = .014) and ESAS-Physical (HR, 1.04; P = .032) scores were associated with worse survival. CONCLUSIONS Baseline PROs are associated with treatment response in patients with advanced gastrointestinal cancer, namely physical symptoms and functional QOL, in addition to health care use and survival. The findings of the current study support the association between PROs and important clinical outcomes, including the novel finding of treatment response.
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Affiliation(s)
- Emily E van Seventer
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Madeleine G Fish
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Kathryn Fosbenner
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Katie Kanter
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Amirkasra Mojtahed
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jill N Allen
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Lawrence Blaszkowsky
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Jeffrey W Clark
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Jon Dubois
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Joseph W Franses
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Bruce J Giantonio
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Lipika Goyal
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Samuel J Klempner
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Eric J Roeland
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - David P Ryan
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Colin D Weekes
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Therese Mulvey
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Areej El-Jawahri
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Nora Horick
- Department of Statistics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ryan B Corcoran
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Aparna R Parikh
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Ryan D Nipp
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
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8
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Ullrich A, Grube K, Hlawatsch C, Bokemeyer C, Oechsle K. Exploring the gender dimension of problems and needs of patients receiving specialist palliative care in a German palliative care unit - the perspectives of patients and healthcare professionals. BMC Palliat Care 2019; 18:59. [PMID: 31315678 PMCID: PMC6637603 DOI: 10.1186/s12904-019-0440-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 07/01/2019] [Indexed: 11/10/2022] Open
Abstract
Background Gender disparities of specific symptoms and problems have frequently been observed in palliative care patients, but research rarely focused on the range of problems and needs affected by gender. Methods We conducted semi-structured interviews with patients and healthcare professionals (HCPs) of a hospital-based palliative care unit to examine gender effects on patients’ problems and needs based on systematically gathered qualitative data. Content analysis was used to identify emerging themes with data coded using MAXQDA. Results Ten patients (5 female, 5 male) and 17 HCPs (12 female, 5 male) were interviewed. Seven categories of gender-specific problems and needs emerged: “physical symptoms, care and body image”, “psychological symptoms and emotional response”, “interaction with the palliative care team”, “use of professional supportive measures”, “activation of informal social networks”, “decision-making”, and “preservation of autonomy and identity”. Both patients and HCPs felt that female patients adopt more expressive coping strategies, have stronger need for communication with and support of HCPs, and activate an extended social network for support and decision-making. Further, both groups thought that male patients mainly rely on social support from partners, have higher expectations to be cared for at home, and have higher need for preservation of autonomy. Conclusion Gender relevantly impacts patients’ problems and needs during palliative care. Therefore, gender-sensitive palliative care that acknowledges the patient’s individual situation and respective ramifications are required.
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Affiliation(s)
- Anneke Ullrich
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Hubertus Wald University Cancer Center Hamburg, Martinistr. 52, 20246, Hamburg, Germany.
| | - Kristina Grube
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Hubertus Wald University Cancer Center Hamburg, Martinistr. 52, 20246, Hamburg, Germany
| | - Cornelia Hlawatsch
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Hubertus Wald University Cancer Center Hamburg, Martinistr. 52, 20246, Hamburg, Germany
| | - Carsten Bokemeyer
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Hubertus Wald University Cancer Center Hamburg, Martinistr. 52, 20246, Hamburg, Germany
| | - Karin Oechsle
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Hubertus Wald University Cancer Center Hamburg, Martinistr. 52, 20246, Hamburg, Germany
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9
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Sutradhar R, Atzema C, Seow H, Earle C, Porter J, Howell D, Dudgeon D, Barbera L. Is Performance Status Associated with Symptom Scores? J Palliat Care 2018. [DOI: 10.1177/082585971403000205] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Symptom scores and performance status are both important measures for patients with cancer. However, since performance status is not often part of routinely collected data, there is interest in exploring whether it can be calculated from symptom scores. Methods: This was a population-based longitudinal study of cancer outpatients in Ontario, Canada in the year following their cancer diagnosis and among the subset of patients during the last year of their lives. Results: In the first year after diagnosis, there was a significant relationship between performance status and fatigue and appetite; fatigue and well-being had a significant association with performance status in the last year of life. In both periods, the associations, although statistically significant, were not large enough to be clinically meaningful. Conclusion: Performance status is an important measurement that cannot be substituted or captured with symptom scores; it is important for healthcare providers to record performance scores on a regular basis.
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Affiliation(s)
- Rinku Sutradhar
- R Sutradhar (corresponding author): Department of Biostatistics, Dalla Lana School of Public Health, University of Toronto; and Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, Ontario, Canada M4N 3M5
| | - Clare Atzema
- C Atzema, C Earle: Institute for Clinical Evaluative Sciences, Toronto; and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Hsien Seow
- H Seow: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Craig Earle
- Department of Oncology, McMaster University, Hamilton; and Supportive Cancer Care Research Unit, Hamilton, Ontario, Canada
| | - Joan Porter
- J Porter: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Doris Howell
- D Howell: Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Deborah Dudgeon
- D Dudgeon: Departments of Medicine and Oncology, Queen's University, Kingston, Ontario, Canada
| | - Lisa Barbera
- L Barbera: Institute for Clinical Evaluative Sciences, Toronto; and Departments of Radiation Oncology and Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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10
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Nipp RD, El-Jawahri A, D'Arpino SM, Chan A, Fuh CX, Johnson PC, Lage DE, Wong RL, Pirl WF, Traeger L, Cashavelly BJ, Jackson VA, Ryan DP, Hochberg EP, Temel JS, Greer JA. Symptoms of posttraumatic stress disorder among hospitalized patients with cancer. Cancer 2018; 124:3445-3453. [PMID: 29905935 DOI: 10.1002/cncr.31576] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 05/01/2018] [Accepted: 05/07/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Patients with cancer experience many stressors placing them at risk for posttraumatic stress disorder (PTSD) symptoms, yet little is known about factors associated with PTSD symptoms in this population. This study explored relationships among patients' PTSD symptoms, physical and psychological symptom burden, and risk for hospital readmissions. METHODS We prospectively enrolled patients with cancer admitted for an unplanned hospitalization from August 2015-April 2017. Upon admission, we assessed patients' PTSD symptoms (Primary Care PTSD Screen), as well as physical (Edmonton Symptom Assessment System [ESAS]) and psychological (Patient Health Questionnaire 4 [PHQ-4]) symptoms. We examined associations between PTSD symptoms and patients' physical and psychological symptom burden using linear regression. We evaluated relationships between PTSD symptoms and unplanned hospital readmissions within 90-days using Cox regression. RESULTS We enrolled 954 of 1,087 (87.8%) patients approached, and 127 (13.3%) screened positive for PTSD symptoms. The 90-day hospital readmission rate was 38.9%. Younger age, female sex, greater comorbidities, and genitourinary cancer type were associated with higher PTSD scores. Patients' PTSD symptoms were associated with physical symptoms (ESAS physical: B = 3.41; P < .001), the total symptom burden (ESAS total: B = 5.97; P < .001), depression (PHQ-4 depression: B = 0.67; P < .001), and anxiety symptoms (PHQ-4 anxiety: B = 0.71; P < .001). Patients' PTSD symptoms were associated with a lower risk of hospital readmissions (hazard ratio, 0.81; P = .001). CONCLUSIONS A high proportion of hospitalized patients with cancer experience PTSD symptoms, which are associated with a greater physical and psychological symptom burden and a lower risk of hospital readmissions. Interventions to address patients' PTSD symptoms are needed and should account for their physical and psychological symptom burden. Cancer 2018. © 2018 American Cancer Society.
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Affiliation(s)
- Ryan D Nipp
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - Areej El-Jawahri
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - Sara M D'Arpino
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Andy Chan
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - Charn-Xin Fuh
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - P Connor Johnson
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - Daniel E Lage
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - Risa L Wong
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - William F Pirl
- Department of Psychiatry, Sylvester Comprehensive Cancer Center and University of Miami, Miami, Florida
| | - Lara Traeger
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Barbara J Cashavelly
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - Vicki A Jackson
- Division of Palliative Care, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - David P Ryan
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - Ephraim P Hochberg
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - Jennifer S Temel
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - Joseph A Greer
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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11
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Hausner D, Kevork N, Pope A, Hannon B, Bryson J, Lau J, Rodin G, Le LW, Zimmermann C. Factors associated with discharge disposition on an acute palliative care unit. Support Care Cancer 2018; 26:3951-3958. [PMID: 29850945 DOI: 10.1007/s00520-018-4274-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 05/15/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Acute palliative care units (APCUs) admit patients with cancer for symptom control, transition to community palliative care units or hospice (CPCU/H), or end-of-life care. Prognostication early in the course of admission is crucial for decision-making. We retrospectively evaluated factors associated with patients' discharge disposition on an APCU in a cancer center. METHODS We evaluated demographic, administrative, and clinical data for all patients admitted to the APCU in 2015. Clinical data included cancer diagnosis, delirium screening, and Edmonton Symptom Assessment System (ESAS) symptoms. An ESAS sub-score composed of fatigue, drowsiness, shortness of breath, and appetite (FDSA) was also investigated. Factors associated with patients' discharge disposition (home, CPCU/H, died on APCU) were identified using three-level multinomial logistic regression. RESULTS Among 280 patients, the median age was 65.5 and median length of stay was 10 days; 155 (55.4%) were admitted for symptom control, 65 (23.2%) for transition to CPCU/H, and 60 (21.4%) for terminal care. Discharge dispositions were as follows: 156 (55.7%) died, 63 (22.5%) returned home, and 61 (21.8%) were transferred to CPCU/H. On multivariable analysis, patients who died were less likely to be older (OR 0.97, p = 0.01), or to be admitted for symptom control (OR 0.06, p < 0.0001), and more likely to have a higher FDSA score 21-40 (OR 3.02, p = 0.004). Patients discharged to CPCU/H were less likely to have been admitted for symptom control (OR 0.06, p < 0.0001). CONCLUSION Age, reason for admission, and the FDSA symptom cluster on admission are variables that can inform clinicians about probable discharge disposition on an APCU.
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Affiliation(s)
- David Hausner
- Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Canada.,Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 610 University Ave., 16-712, Toronto, Ontario, M5G 2M9, Canada
| | - Nanor Kevork
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 610 University Ave., 16-712, Toronto, Ontario, M5G 2M9, Canada
| | - Ashley Pope
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 610 University Ave., 16-712, Toronto, Ontario, M5G 2M9, Canada
| | - Breffni Hannon
- Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Canada.,Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 610 University Ave., 16-712, Toronto, Ontario, M5G 2M9, Canada
| | - John Bryson
- Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Canada.,Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 610 University Ave., 16-712, Toronto, Ontario, M5G 2M9, Canada
| | - Jenny Lau
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 610 University Ave., 16-712, Toronto, Ontario, M5G 2M9, Canada.,Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 610 University Ave., 16-712, Toronto, Ontario, M5G 2M9, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Princess Margaret Cancer Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Lisa W Le
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Camilla Zimmermann
- Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Canada. .,Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 610 University Ave., 16-712, Toronto, Ontario, M5G 2M9, Canada. .,Department of Psychiatry, University of Toronto, Toronto, Canada. .,Princess Margaret Cancer Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
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12
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Omran S, Khader Y, McMillan S. Symptom Clusters and Quality of Life in Hospice Patients with Cancer. Asian Pac J Cancer Prev 2017; 18:2387-2393. [PMID: 28950683 PMCID: PMC5720641 DOI: 10.22034/apjcp.2017.18.9.2387] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Symptom control is an important part of palliative care and important to achieve optimal quality
of life (QOL). Studies have shown that patients with advanced cancer suffer from diverse and often severe physical
and psychological symptoms. The aim is to explore the influence of symptom clusters on QOL among patients with
advanced cancer. Materials and Methods: 709 patients with advanced cancer were recruited to participate in a clinical
trial focusing on symptom management and QOL. Patients were adults newly admitted to hospice home care in one of
two hospices in southwest Florida, who could pass mental status screening. The instruments used for data collection
were the Demographic Data Form, Memorial Symptom Assessment Scale (MSAS), and the Hospice Quality of Life
Index-14. Results: Exploratory factor analysis and multiple regression were used to identify symptom clusters and their
influence on QOL. The results revealed that the participants experienced multiple concurrent symptoms. There were
four symptom clusters found among these cancer patients. Individual symptom distress scores that were the strongest
predictors of QOL were: feeling pain; dry mouth; feeling drowsy; nausea; difficulty swallowing; worrying and feeling
nervous. Conclusions: Patients with advanced cancer reported various concurrent symptoms, and these form symptom
clusters of four main categories. The four symptoms clusters have a negative influence on patients’ QOL and required
specific care from different members of the hospice healthcare team. The results of this study should be used to guide
health care providers’ symptom management. Proper attention to symptom clusters should be the basis for accurate
planning of effective interventions to manage the symptom clusters experienced by advanced cancer patients. The
health care provider needs to plan ahead for these symptoms and manage any concurrent symptoms for successful
promotion of their patient’s QOL.
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Affiliation(s)
- Suha Omran
- Adult Health Department, Faculty of Nursing, Jordan University of Science and Technology, Jordan.
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13
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Miladinia M, Baraz S, Ramezani M, Malehi AS. The relationship between pain, fatigue, sleep disorders and quality of life in adult patients with acute leukaemia: During the first year after diagnosis. Eur J Cancer Care (Engl) 2017; 27. [DOI: 10.1111/ecc.12762] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Mojtaba Miladinia
- Bostan Nursing faculty; Ahvaz Jundishapur University of Medical Sciences; Ahvaz Iran
| | - Shahram Baraz
- Nursing care Research Center in Chronic Diseases; School of Nursing and Midwifery; Ahvaz Jundishapur University of Medical Sciences; Ahvaz Iran
| | - Monir Ramezani
- School of Nursing and Midwifery; Mashhad University of Medical Sciences; Mashhad Iran
| | - Amal Saki Malehi
- Health Research Institute; Research Center of Thalassemia & Hemoglobinopathy; Ahvaz Jundishapur University of Medical Sciences; Ahvaz Iran
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14
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Clark K, Bergerot CD, Philip EJ, Buga S, Obenchain R, Loscalzo MJ. Biopsychosocial problem-related distress in cancer: examining the role of sex and age. Psychooncology 2016; 26:1562-1568. [DOI: 10.1002/pon.4172] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 04/13/2016] [Accepted: 05/08/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Karen Clark
- Sheri & Les Biller Patient and Family Resource Center, Department of Supportive Medicine; City of Hope; Duarte CA USA
| | | | - Errol J. Philip
- The Notre Dame Laboratory for Psycho-Oncology Research; Notre Dame; Notre Dame IN USA
| | - Sorin Buga
- Sheri & Les Biller Patient and Family Resource Center, Department of Supportive Medicine; City of Hope; Duarte CA USA
| | - Richard Obenchain
- Sheri & Les Biller Patient and Family Resource Center, Department of Supportive Medicine; City of Hope; Duarte CA USA
| | - Matthew J. Loscalzo
- Sheri & Les Biller Patient and Family Resource Center, Department of Supportive Medicine; City of Hope; Duarte CA USA
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15
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López E, de la Torre-Luque A, Lazo A, Álvarez J, Buela-Casal G. Assessment of sleep disturbances in patients with cancer: Cross-sectional study in a radiotherapy department. Eur J Oncol Nurs 2016; 20:71-6. [DOI: 10.1016/j.ejon.2014.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 12/27/2014] [Accepted: 12/31/2014] [Indexed: 11/17/2022]
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16
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Hui D, Shamieh O, Paiva CE, Khamash O, Perez-Cruz PE, Kwon JH, Muckaden MA, Park M, Arthur J, Bruera E. Minimal Clinically Important Difference in the Physical, Emotional, and Total Symptom Distress Scores of the Edmonton Symptom Assessment System. J Pain Symptom Manage 2016; 51:262-9. [PMID: 26482223 PMCID: PMC4733575 DOI: 10.1016/j.jpainsymman.2015.10.004] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 10/08/2015] [Accepted: 10/10/2015] [Indexed: 12/25/2022]
Abstract
CONTEXT The Edmonton Symptom Assessment System (ESAS) is one of the most commonly used symptom batteries in clinical practice and research. OBJECTIVES We used the anchor-based approach to identify the minimal clinically important difference (MCID) for improvement and deterioration for ESAS physical, emotional, and total symptom distress scores. METHODS In this multicenter prospective study, we asked patients with advanced cancer to complete their ESAS at the first clinic visit and at a second visit three weeks later. The anchor for MCID determination was Patient's Global Impression regarding their physical, emotional, and overall symptom burden ("better," "about the same," or "worse"). We identified the optimal sensitivity/specificity cutoffs for both improvement and deterioration for the three ESAS scores and also determined the within-patient changes. RESULTS A total of 796 patients were enrolled from six centers. The ESAS scores had moderate responsiveness, with area under the receiver operating characteristic curve between 0.69 and 0.76. Using the sensitivity-specificity approach, the optimal cutoffs for ESAS physical, emotional, and total symptom distress scores were ≥3/60, ≥2/20, and ≥3/90 for improvement, and ≤-4/60, ≤-1/20, and ≤-4/90 for deterioration, respectively. These cutoffs had moderate sensitivities (59%-68%) and specificities (62%-80%). The within-patient change approach revealed the MCID cutoffs for improvement/deterioration to be 3/-4.3 for the physical score, 2.4/-1.8 for the emotional score, and 5.7/-2.9 for the total symptom distress score. CONCLUSION We identified the MCIDs for physical, emotional, and total symptom distress scores, which have implications for interpretation of symptom response in clinical trials.
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Affiliation(s)
- David Hui
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
| | - Omar Shamieh
- Department of Palliative Care, King Hussein Cancer Center, Amman, Jordan
| | | | - Odai Khamash
- Department of Palliative Care, King Hussein Cancer Center, Amman, Jordan
| | - Pedro Emilio Perez-Cruz
- Departamento Medicina Interna, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jung Hye Kwon
- Department of Medical Oncology, Kangdong Sacred Heart Hospital, Seoul, Republic of Korea
| | | | - Minjeong Park
- Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Joseph Arthur
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
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17
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Kim Y, Yen IH, Rabow MW. Comparing Symptom Burden in Patients with Metastatic and Nonmetastatic Cancer. J Palliat Med 2016; 19:64-8. [DOI: 10.1089/jpm.2011.0456] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Yunie Kim
- University of California, San Francisco. Division of General Internal Medicine, San Francisco, California
| | - Irene H. Yen
- University of California, San Francisco. Division of General Internal Medicine, San Francisco, California
| | - Michael W. Rabow
- University of California, San Francisco. Division of General Internal Medicine, San Francisco, California
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18
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Sutradhar R, Atzema C, Seow H, Earle C, Porter J, Barbera L. Repeated assessments of symptom severity improve predictions for risk of death among patients with cancer. J Pain Symptom Manage 2014; 48:1041-9. [PMID: 24768594 DOI: 10.1016/j.jpainsymman.2014.02.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 02/19/2014] [Accepted: 04/02/2014] [Indexed: 10/25/2022]
Abstract
CONTEXT Although prior studies show the importance of self-reported symptom scores as predictors of cancer survival, most are based on scores recorded at a single point in time. OBJECTIVES To show that information on repeated assessments of symptom severity improves predictions for risk of death and to use updated symptom information for determining whether worsening of symptom scores is associated with a higher hazard of death. METHODS This was a province-based longitudinal study of adult outpatients who had a cancer diagnosis and had assessments of symptom severity. We implemented a time-to-death Cox model with a time-varying covariate for each symptom to account for changing symptom scores over time. This model was compared with that using only a time-fixed (baseline) covariate for each symptom. The regression coefficients of each model were derived based on a randomly selected 60% of patients, and then, the predictive performance of each model was assessed via concordance probabilities when applied to the remaining 40% of patients. RESULTS This study had 66,112 patients diagnosed with cancer and more than 310,000 assessments of symptoms. The use of repeated assessments of symptom scores improved predictions for risk of death compared with using only baseline symptom scores. Increased pain and fatigue and reduced appetite were the strongest predictors for death. CONCLUSION If available, researchers should consider including changing information on symptom scores, as opposed to only baseline information on symptom scores, when examining hazard of death among patients with cancer. Worsening of pain, fatigue, and appetite may be a flag for impending death.
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Affiliation(s)
- Rinku Sutradhar
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | - Clare Atzema
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Hsien Seow
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Oncology, Hamilton, Ontario, Canada; Supportive Cancer Care Research Unit, McMaster University, Hamilton, Ontario, Canada
| | - Craig Earle
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Joan Porter
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Lisa Barbera
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Hannon B, Swami N, Pope A, Rodin G, Dougherty E, Mak E, Banerjee S, Bryson J, Ridley J, Zimmermann C. The oncology palliative care clinic at the Princess Margaret Cancer Centre: an early intervention model for patients with advanced cancer. Support Care Cancer 2014; 23:1073-80. [DOI: 10.1007/s00520-014-2460-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 09/22/2014] [Indexed: 12/25/2022]
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21
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Krok J, Baker T, McMillan S. Sexual activity and body image: examining gender variability and the influence of psychological distress in cancer patients. JOURNAL OF GENDER STUDIES 2013; 22:409-422. [PMID: 24778465 PMCID: PMC3999973 DOI: 10.1080/09589236.2012.708828] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Psychosocial factors impacting on the overall quality of life for cancer patients may differ between men and women. This study examined the influence that psychological distress, clinical, and social variables have on sexual activity and body image in adult oncology patients. Symptom data was collected from the Memorial Symptom Assessment Scale (MSAS). Analysis indicated women and patients with reported functional limitations were more likely to be less satisfied with how they looked. The final model showed that younger adults, Caucasians, those who were married and patients with some functional limitations were more likely to have problems with sexual interest/activity. Gender was not a significant predictor of having problems with sexual interest/activity. These results can be used by clinicians to identify patients who may be at an increased risk for negative body image and problems in sexual functioning. Further research regarding gender differences in cancer-related psychological symptoms is needed to assist healthcare professionals in providing comprehensive care while alleviating unresolved and interrelated health and psychosocial symptoms.
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Affiliation(s)
- Jessica Krok
- The Ohio State University, Comprehensive Cancer Center 1590 N. High Street, Suite 525, Columbus, OH 43201
| | - Tamara Baker
- University of South Florida, School of Aging Studies 13301 Bruce B. Downs Blvd., MHC 1300, Tampa, FL 33612
| | - Susan McMillan
- University of South Florida, College of Nursing 12901 Bruce B. Downs Blvd., MDC Box 22, Tampa, FL 33612
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22
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Vrettos I, Kamposioras K, Kontodimopoulos N, Pappa E, Georgiadou E, Haritos D, Papadopoulos AA, Niakas D. Comparing health-related quality of life of cancer patients under chemotherapy and of their caregivers. ScientificWorldJournal 2012; 2012:135283. [PMID: 22619584 PMCID: PMC3348659 DOI: 10.1100/2012/135283] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Accepted: 12/21/2011] [Indexed: 11/17/2022] Open
Abstract
Introduction. Cancer is a major disorder physically and psychologically affecting both patients and their caregivers. In this study, health-related quality of life (HRQoL) of patient-caregiver dyads during the period of chemotherapy was assessed. Material and Methods. Two hundred twenty-two cancer patient-caregiver dyads were enrolled in the study, which was conducted from October 2008 to March 2009. HRQoL was evaluated with EQ-5D. Results. The mean age of the sample was 57.4 and 48.9 for patients and caregivers, respectively. The EQ-5D descriptive system indicates that female patients more frequently experience anxiety and depression than male patients. Male and higher-education caregivers had higher VAS scores, while demographic factors did not seem to influence patients' HRQoL. Anxiety and depression of caregivers were correlated with patients' problems in self-care and usual activities. Conclusions. Quality of life is highly influenced during the period of chemotherapy for both patients and caregivers and is often under reported. Interventions that can improve HRQoL, especially in the domain of mental health for both cancer patients and their caregivers, need to be implemented.
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Affiliation(s)
- Ioannis Vrettos
- Second Department of Internal Medicine, Medical School, Attikon University General Hospital, P.C. 12462 Athens, Greece
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Bergh I, Kvalem IL, Aass N, Hjermstad MJ. What does the answer mean? A qualitative study of how palliative cancer patients interpret and respond to the Edmonton Symptom Assessment System. Palliat Med 2011; 25:716-24. [PMID: 21248179 DOI: 10.1177/0269216310395985] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The Edmonton Symptom Assessment System (ESAS) is a well-known self-reporting tool for symptom assessment in palliative care. Research has shown that patients experience difficulties in the scoring and interpretation, which may lead to suboptimal treatment. The aims were to examine how palliative care cancer patients interpreted and responded to the ESAS. Eleven patients (3 F/8 M), median age 65 (34-95) with mixed diagnoses were interviewed by means of cognitive interviewing, immediately after having completed the ESAS. The highest mean scores were found with tiredness (6.3) and oral dryness (5.7). The results showed that sources of error were related to interpretation of symptoms and differences in the understanding and use of the response format. The depression and anxiety symptoms were perceived as difficult to interpret, while the appetite item was particularly prone to misunderstandings. Contextual factors, such as mood and time of the day, influenced the answers. Lack of information and feedback from staff influenced the scores. Some patients stated that they scored at random because they did not understand why and how the ESAS was used. The patients' interpretation must be considered in order to minimize errors. The ESAS should always be reviewed with the patients after completion to improve symptom management, thereby strengthening the usability of the ESAS.
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Affiliation(s)
- Irmelin Bergh
- Department of Oncology, Oslo University Hospital, Norway.
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Pud D. Gender differences in predicting quality of life in cancer patients with pain. Eur J Oncol Nurs 2011; 15:486-91. [PMID: 21256079 DOI: 10.1016/j.ejon.2010.12.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Revised: 12/13/2010] [Accepted: 12/16/2010] [Indexed: 11/12/2022]
Abstract
PURPOSE Numerous studies have identified several factors influencing quality of life (QOL) in cancer patients. However, studies on gender differences in cancer-related physical symptoms and QOL levels have yielded inconsistent results. The present study examined common symptoms (i.e., pain intensity, fatigue, and depression) in regard to their ability to predict QOL in male and female oncology patients with cancer pain. METHOD A total of 114 oncology outpatients, including 34 males and 80 females, with pain completed a demographic questionnaire, the Multidimensional Quality of Life Scale - Cancer, the Lee Fatigue Scale, the Center for Epidemiological Studies - Depression Scale, and a numeric rating scale for pain intensity. RESULTS The female patients reported significantly lower psychological dimension of QOL than their male counterparts (p=0.009). Also for the females, a negative correlation was found between pain intensity and QOL (r=-0.504, p<0.0001), as well as positive correlations between pain intensity and fatigue (r=0.421, p<0.0001) and depression (r=0.368, p<0.0001). Stepwise linear regression analyses showed that among the females, QOL was significantly predicted by pain intensity as well as by depression (F((2,75))=52.62, p<0.0001, Adj. R(2)=0.57). However, among the males, depression was the only symptom found to predict QOL (F((2,30))=9.72, p<0.001, Adj. R(2)=0.39). CONCLUSION Therefore, it is concluded that gender should be considered as an additional feature for further characterizing QOL. Gender differences in factors predicting QOL warrant different clinical approaches to male and female patients, and identifying these differences may assist health care providers in tailoring treatment modalities to individual patients for optimal outcomes.
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Affiliation(s)
- Dorit Pud
- Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.
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