Jung Hun Kang1, Jung Hye Kwon, David Hui, Sriram Yennurajalingam, Eduardo Bruera. 1. Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, Institute of Health Science, School of Medicine, Gyeongsang National University, Jinju, Republic of Korea.
Abstract
CONTEXT: Symptom changes are usually reported using summary statistics such as mean and/or median, which may obscure the treatment effect. OBJECTIVES: The main objective of this retrospective study was to determine the magnitude of symptom changes as assessed by the Edmonton Symptom Assessment System (ESAS) after outpatient palliative care at the first follow-up visit. METHODS: We reviewed 1612 consecutive patients with cancer who were referred to the outpatient Supportive Care Center and who completed the ESAS at the initial and first follow-up visits between January 2003 and December 2010. All patients received interdisciplinary care led by the palliative care specialists following an institutional protocol. RESULTS: The distribution of the magnitude of symptom changes was stratified by baseline intensities. Patterns were similar for different ESAS items. At the follow-up visit (median: 15 days later), 52-74% of patients showed a decrease of one or more points in the ESAS score. However, 48-80% of patients with moderate/severe intensity at baseline complained of symptoms with an ESAS score of four or more after outpatient palliative care. Symptoms with absent/mild intensity worsened, ranging from a mean of -3.04 to 0.12 at the first follow-up visit, whereas symptoms with moderate/severe intensity improved from -0.2 to 3.86 (P<0.001). CONCLUSION: A considerable proportion of patients with moderate or severe intensity at baseline still had symptoms with an ESAS score of four or more. Patients with absent/mild intensities at baseline complained of symptom exacerbation at the first follow-up visit. Various strategies are needed to optimize symptom control in advanced cancer.
CONTEXT: Symptom changes are usually reported using summary statistics such as mean and/or median, which may obscure the treatment effect. OBJECTIVES: The main objective of this retrospective study was to determine the magnitude of symptom changes as assessed by the Edmonton Symptom Assessment System (ESAS) after outpatient palliative care at the first follow-up visit. METHODS: We reviewed 1612 consecutive patients with cancer who were referred to the outpatient Supportive Care Center and who completed the ESAS at the initial and first follow-up visits between January 2003 and December 2010. All patients received interdisciplinary care led by the palliative care specialists following an institutional protocol. RESULTS: The distribution of the magnitude of symptom changes was stratified by baseline intensities. Patterns were similar for different ESAS items. At the follow-up visit (median: 15 days later), 52-74% of patients showed a decrease of one or more points in the ESAS score. However, 48-80% of patients with moderate/severe intensity at baseline complained of symptoms with an ESAS score of four or more after outpatient palliative care. Symptoms with absent/mild intensity worsened, ranging from a mean of -3.04 to 0.12 at the first follow-up visit, whereas symptoms with moderate/severe intensity improved from -0.2 to 3.86 (P<0.001). CONCLUSION: A considerable proportion of patients with moderate or severe intensity at baseline still had symptoms with an ESAS score of four or more. Patients with absent/mild intensities at baseline complained of symptom exacerbation at the first follow-up visit. Various strategies are needed to optimize symptom control in advanced cancer.
Authors: N Fridriksdottir; S Gunnarsdottir; S Zoëga; B Ingadottir; E J G Hafsteinsdottir Journal: Support Care Cancer Date: 2017-09-18 Impact factor: 3.603
Authors: Marvin Omar Delgado Guay; Marvin Omar Delgado Guay; Silvia Tanzi; Maria Teresa San Miguel Arregui; Maria Teresa San Miguel Arregui; Gary Chisholm; Maxine G De la Cruz; Maxine de la Cruz; Eduardo Bruera Journal: Support Care Cancer Date: 2014-04-26 Impact factor: 3.603
Authors: David Hui; Minjeong Park; Omar Shamieh; Carlos Eduardo Paiva; Pedro Emilio Perez-Cruz; Mary Ann Muckaden; Eduardo Bruera Journal: Cancer Date: 2016-03-11 Impact factor: 6.860