Province-wide analysis of patient reported outcomes for stage IV non-small cell lung cancer.

Abstract

12092 Background: Stage IV NSCLC patients have significant disease and treatment-related morbidity. In Ontario, Canada, cancer patients complete Edmonton Symptom Assessment System (ESAS) questionnaires, a tool that elicits patients’ self-reported severity of common cancer-associated symptoms at clinical encounters. ESAS domains are: anxiety, depression, drowsiness, appetite, nausea, pain, shortness of breath, tiredness and well-being. The purpose of this study is to examine moderate-to-severe symptom burden in the 12 months following a diagnosis of stage IV NSCLC. Methods: Using administrative databases and unique encoded identifiers, stage IV NSCLC diagnosed between January 2007 and September 2018 were evaluated for symptom screening with ESAS in the 12 months following diagnosis. Proportion of patients reporting moderate-to-severe score (i.e. ESAS ≥4) in each domain within 12 months were calculated. Patients reporting moderate-to-severe within the different ESAS domains of were plotted over time. Multivariable (MV) Poisson regression models with potential covariates such as age, sex, Elixhauser comorbidity index, income quintiles, and lung cancer treatments received were constructed to identify factors associated with moderate-to-severe symptoms. Results: Of 22,799 stage IV NSCLC patients, 13,289 (58.3%) had completed ESAS (84,373 unique assessments) in the year following diagnosis. Patients with older age, high comorbidity, and not receiving active cancer therapy were less likely to complete ESAS. Most (94.4%) reported at least 1 moderate-to-severe score. Most prevalent moderate-to-severe ESAS symptoms within 12 months after diagnosis were tiredness (84.1%), lack of wellbeing (80.7%), low appetite (71.7%), and shortness of breath (67.8%); nausea was the least prevalent (34.6%). Most symptoms peaked at diagnosis and persisted in the year after diagnosis. On adjusted MV analyses, patients with high comorbidity, low income, and urban residency were associated with increased moderate-to-severe symptoms. Moderate-to-severe scores in all ESAS symptoms were associated with delivery of radiotherapy within 2 weeks prior, while moderate-to-severe nausea, drowsiness, tiredness, low appetite, and lack of wellbeing were associated with delivery of systemic therapy within preceding 2 weeks. Conclusions: In this population-based analysis of stage IV NSCLC PROs in the year following diagnosis, moderate-to-severe symptoms were highly prevalent and persistently high, underscoring the need to address supportive requirements in this at-risk population.

Dyspnea in patients with stage IV non-small cell lung cancer: a population-based analysis of disease burden and patterns of care

“…Limitations of our study include the risk of selection bias introduced by the nearly 40% ESAS non-completion rate of our initial patient cohort. As observed in our previous report, non-respondents were more likely to be older, have higher ECI scores, and not receive active oncologic therapy (10). This limits the generalizability of the findings of the current study and suggests that the non-ESAS respondents may have not received care at a cancer center in Ontario, where implementation of the ESAS questionnaire was standard.…”

“…The details of our data sources and methods have been described previously (10). Briefly, we queried the provincial Institute for Clinical Evaluative Sciences (ICES) database for all eligible patients with available ESAS information.…”

“…Endpoints were stratified by the exposure variable of ESAS dyspnea score. A moderateto-severe dyspnea score was defined as ≥4 out of 10 consistent with our initial report and literature cutoffs; otherwise, patients were considered to have a low score (7,10,15). Furthermore, we characterized the interventions received for patients reporting moderate-to-severe dyspnea score(s) and their association with baseline covariates in an exploratory manner.…”

“…The provincial implementation of the ESAS tool allows for a unique opportunity to quantify and assess the symptom burden at the population level, and we have previously reported the overall symptom distribution of stage IV lung cancer patients, as measured through ESAS (10). In the current study, we focus on the subset of metastatic lung cancer patients reporting a moderate-to-severe dyspnea score, with the aim to establish factors associated with dyspnea, as well as characteristics associated with the use of interventions commonly used to treat dyspnea in lung cancer.…”