Determination of Cutpoints for Low and High Number of Symptoms in Patients with Advanced Cancer

Abstract

While patients with advanced cancer experience a wide range of symptoms, no work has been done to determine an optimal cutpoint for a low versus a high number of symptoms. Analytic approaches that established clinically meaningful cutpoints for the severity of cancer pain and fatigue provided the foundation for this study. The purpose of this study was to determine the optimal cutpoint for low and high numbers of symptoms using a range of potential cutpoints and to determine if those cutpoints distinguished between the two symptom groups on demographic and clinical characteristics and depression, anxiety, and quality of life (QOL). Patients with advanced cancer (n = 110) completed a symptom assessment scale, and measures of depression, anxiety, and QOL. Combinations of cutpoints were tested to yield one-and two-cutpoint solutions. Using analysis of variance for QOL scores, the F-ratio that indicated the highest between-group difference was determined to be the optimal cutpoint between low and high number of symptoms. A cutpoint of £ 12 symptoms (i.e., 0-12 is low, 13-32 is high) was the optimal cutpoint for total number of symptoms. Significant differences in depression, anxiety, and QOL scores validated this cutpoint. Psychological symptoms had higher occurrence rates in the high symptom group. Findings suggest that a threshold exists between a low and a high number of symptoms in patients with advanced cancer. Psychological symptoms were significantly different between patients in the low versus high symptom groups and may play an important role in QOL outcomes in patients with advanced cancer.

Changes in the Occurrence, Severity, and Distress of Symptoms in Patients With Gastrointestinal Cancers Receiving Chemotherapy

“…Given the paucity of longitudinal studies of the symptom experience of patients with GI cancers, the purpose of this study was to evaluate for changes over time in the occurrence, severity, and distress of seven common symptoms (i.e., pain, lack of energy, nausea, feeling drowsy, numbness/tingling in hands/feet, difficulty sleeping, change in the way food tastes) in a sample of patients with GI cancers who were assessed over two cycles of CTX. In addition, the effects of a number of demographic and clinical characteristics that are known to influence cancer patients’ symptom experience (i.e., treatment group (i.e., CTX with and without TT, 2,5 age, 6,7 number of metastatic sites, 8,9 time from cancer diagnosis, 8,9 total number of prior cancer treatments, 8,9 cancer diagnosis, 10 CTX regimen 11 ) on enrollment scores, as well as on changes over time in the various dimensions of the symptom experience were evaluated.…”