Sang-Yeon Suh1,2, Seon-Hye Won2, Yusuke Hiratsuka3, Sung-Eun Choi4, Shao-Yi Cheng5, Masanori Mori6, Ping-Jen Chen7,8, Takashi Yamaguchi9, Tatsuya Morita6, Satoru Tsuneto10, Thomas W LeBlanc11, Sun-Hyun Kim12, Seok-Joon Yoon13, Eon Sook Lee14, Sun Wook Hwang15. 1. Department of Medicine, Dongguk University-Seoul, Seoul, South Korea. 2. Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang si, South Korea. 3. Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan. 4. Department of Statistics, Dongguk University-Seoul, Seoul, South Korea. 5. Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan. 6. Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan. 7. Department of Family Medicine, Kaohsiung Medical University Hospital, and School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. 8. Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, United Kingdom. 9. Division of Palliative Care, Konan Medical Center, Kobe, Japan. 10. Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan. 11. Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina, USA. 12. Department of Family Medicine, School of Medicine, Catholic Kwandong University International St. Mary's Hospital, Incheon, South Korea. 13. Department of Family Medicine, Chungnam National University School of Medicine, Daejeon, South Korea. 14. Department of Family Medicine, Ilsan-Paik Hospital, College of Medicine, Inje University, Goyang, Korea. 15. Department of Family Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.
Abstract
Background: Symptoms are not typically part of established various prognostic factors and scoring systems but are among the most frequently assessed issues in patient care. Objectives: To evaluate that, changes in symptoms can provide additional useful prognostic information. Design: A secondary analysis of an international cohort study in Japan, Korea, and Taiwan. Setting/Subjects: Subjects were adult patients with advanced cancer (n = 2074) who were admitted to 37 palliative care units (PCUs) in 3 countries from January 2017 to September 2018. Measurements: Symptoms (dyspnea, fatigue, dry mouth, and drowsiness) were assessed at admission and one-week later. Dyspnea was assessed by the presence of resting and exertional dyspnea, whereas other symptoms were assessed using the Integrated Palliative care Outcome Scales (IPOS) (range 0-4). For analysis, we grouped patients by symptom change, as either Improved, Stable, or Worsened (by having at least a one increment decrease, no change, or at least a one increment increase, respectively). Results: Worsened groups had the shortest survival (median survival 15-21 days) compared with those with Improved (median survival 23-31 days) and Stable symptoms (median survival 27-29 days) across all four symptoms (dyspnea, fatigue, dry mouth, and drowsiness). Survival differences were statistically significantly different across all three groups for all symptoms (all p < 0.001). Interestingly, Improved symptoms were associated with similar survival compared with Stable groups, with no statistical differences. Conclusions: Worsened symptoms at one week after admission were useful predictors of survival for patients with advanced cancer in PCUs during the final weeks of life. Longitudinal assessments are needed to reflect passage of time as well as impact of treatments.
Background: Symptoms are not typically part of established various prognostic factors and scoring systems but are among the most frequently assessed issues in patient care. Objectives: To evaluate that, changes in symptoms can provide additional useful prognostic information. Design: A secondary analysis of an international cohort study in Japan, Korea, and Taiwan. Setting/Subjects: Subjects were adult patients with advanced cancer (n = 2074) who were admitted to 37 palliative care units (PCUs) in 3 countries from January 2017 to September 2018. Measurements: Symptoms (dyspnea, fatigue, dry mouth, and drowsiness) were assessed at admission and one-week later. Dyspnea was assessed by the presence of resting and exertional dyspnea, whereas other symptoms were assessed using the Integrated Palliative care Outcome Scales (IPOS) (range 0-4). For analysis, we grouped patients by symptom change, as either Improved, Stable, or Worsened (by having at least a one increment decrease, no change, or at least a one increment increase, respectively). Results: Worsened groups had the shortest survival (median survival 15-21 days) compared with those with Improved (median survival 23-31 days) and Stable symptoms (median survival 27-29 days) across all four symptoms (dyspnea, fatigue, dry mouth, and drowsiness). Survival differences were statistically significantly different across all three groups for all symptoms (all p < 0.001). Interestingly, Improved symptoms were associated with similar survival compared with Stable groups, with no statistical differences. Conclusions: Worsened symptoms at one week after admission were useful predictors of survival for patients with advanced cancer in PCUs during the final weeks of life. Longitudinal assessments are needed to reflect passage of time as well as impact of treatments.
Entities:
Keywords:
advanced cancer; changes of symptoms; prediction; survival