Qiuling Shi1, Ju-Whei Lee2, Xin Shelley Wang1, Michael J Fisch3, Victor T Chang4, Lynne Wagner5, Charles S Cleeland1. 1. Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX. 2. ECOG-ACRIN Biostatistics Center, Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA. 3. AIM Specialty Health, Chicago, IL. 4. Veteran Affairs New Jersey Health Care System, East Orange, New Jersey; Rutgers New Jersey Medical School, Newark, NJ. 5. Wake Forest University Health Services, Winston-Salem, NC.
Abstract
PURPOSE: Symptom monitoring is attracting attention as a way to improve adherence to cancer therapy, reduce treatment-related toxicities, and possibly improve overall survival. How reporting thresholds affect symptom alert generation and clinical outcomes is poorly understood. PATIENTS AND METHODS: We analyzed data from 38 US health care institutions collected for the prospective Eastern Cooperative Oncology Group-American College of Radiology Imaging Network E2Z02 Symptom Outcomes and Practice Patterns study. Participants were outpatients receiving chemotherapy for breast (n = 642), colorectal (n = 486), or lung cancer (n = 340) who rated symptom severity using the MD Anderson Symptom Inventory at 2 assessment points 1 month apart. Percentages of patients with pain, dyspnea, fatigue, or distress at different thresholds (score of 4-7 on a 0-10 scale) were compared. The percentage of patients whose performance status had worsened at follow-up was used to estimate risk for missing clinically important symptom data by using higher severity thresholds. RESULTS: At the guideline-recommended threshold of ≥ 4, suprathreshold rates were 60% for any of the 4 symptoms at the initial survey; performance status worsened at follow-up for 27% of all patients with any symptom rated ≥ 4 at the initiate survey. When the threshold was increased to ≥ 7, approximately half of patients (51%) with worsened performance status were not identified. CONCLUSION: The burden to clinicians from an alert threshold of ≥ 4 (per many current guidelines) would be substantial. However, setting higher alert thresholds may miss a large percentage of patients who need clinical intervention. These results may inform resource planning when implementing electronic symptom screening at an institutional or practice level.
PURPOSE: Symptom monitoring is attracting attention as a way to improve adherence to cancer therapy, reduce treatment-related toxicities, and possibly improve overall survival. How reporting thresholds affect symptom alert generation and clinical outcomes is poorly understood. PATIENTS AND METHODS: We analyzed data from 38 US health care institutions collected for the prospective Eastern Cooperative Oncology Group-American College of Radiology Imaging Network E2Z02 Symptom Outcomes and Practice Patterns study. Participants were outpatients receiving chemotherapy for breast (n = 642), colorectal (n = 486), or lung cancer (n = 340) who rated symptom severity using the MD Anderson Symptom Inventory at 2 assessment points 1 month apart. Percentages of patients with pain, dyspnea, fatigue, or distress at different thresholds (score of 4-7 on a 0-10 scale) were compared. The percentage of patients whose performance status had worsened at follow-up was used to estimate risk for missing clinically important symptom data by using higher severity thresholds. RESULTS: At the guideline-recommended threshold of ≥ 4, suprathreshold rates were 60% for any of the 4 symptoms at the initial survey; performance status worsened at follow-up for 27% of all patients with any symptom rated ≥ 4 at the initiate survey. When the threshold was increased to ≥ 7, approximately half of patients (51%) with worsened performance status were not identified. CONCLUSION: The burden to clinicians from an alert threshold of ≥ 4 (per many current guidelines) would be substantial. However, setting higher alert thresholds may miss a large percentage of patients who need clinical intervention. These results may inform resource planning when implementing electronic symptom screening at an institutional or practice level.
Authors: Ethan Basch; Allison M Deal; Amylou C Dueck; Howard I Scher; Mark G Kris; Clifford Hudis; Deborah Schrag Journal: JAMA Date: 2017-07-11 Impact factor: 56.272
Authors: Roxanne E Jensen; Arnold L Potosky; Carol M Moinpour; Tania Lobo; David Cella; Elizabeth A Hahn; David Thissen; Ashley Wilder Smith; Jaeil Ahn; George Luta; Bryce B Reeve Journal: J Clin Oncol Date: 2017-04-20 Impact factor: 44.544
Authors: Lev D Bubis; Laura Davis; Alyson Mahar; Lisa Barbera; Qing Li; Lesley Moody; Paul Karanicolas; Rinku Sutradhar; Natalie G Coburn Journal: J Clin Oncol Date: 2018-03-01 Impact factor: 44.544
Authors: Michael J Fisch; Ju-Whei Lee; Matthias Weiss; Lynne I Wagner; Victor T Chang; David Cella; Judith B Manola; Lori M Minasian; Worta McCaskill-Stevens; Tito R Mendoza; Charles S Cleeland Journal: J Clin Oncol Date: 2012-04-16 Impact factor: 44.544
Authors: Eivor A Laugsand; Mirjam A G Sprangers; Kristin Bjordal; Frank Skorpen; Stein Kaasa; Pål Klepstad Journal: Health Qual Life Outcomes Date: 2010-09-21 Impact factor: 3.186
Authors: Bryce B Reeve; Sandra A Mitchell; Amylou C Dueck; Ethan Basch; David Cella; Carolyn Miller Reilly; Lori M Minasian; Andrea M Denicoff; Ann M O'Mara; Michael J Fisch; Cynthia Chauhan; Neil K Aaronson; Corneel Coens; Deborah Watkins Bruner Journal: J Natl Cancer Inst Date: 2014-07-08 Impact factor: 13.506
Authors: Kristine A Donovan; Heidi S Donovan; David Cella; Martha E Gaines; Richard T Penson; Steven C Plaxe; Vivian E von Gruenigen; Deborah Watkins Bruner; Bryce B Reeve; Lari Wenzel Journal: J Natl Cancer Inst Date: 2014-07-08 Impact factor: 13.506
Authors: Kathi H Mooney; Susan L Beck; Bob Wong; William Dunson; Debra Wujcik; Meagan Whisenant; Gary Donaldson Journal: Cancer Med Date: 2017-01-30 Impact factor: 4.452