Symptom burden and performance status in a population‐based cohort of ambulatory cancer patients

Abstract

BACKGROUND. For ambulatory cancer patients, Ontario has standardized symptom and performance status assessment population-wide, using the Edmonton Symptom Assessment System (ESAS) and Palliative Performance Scale (PPS). In a broad cross-section of cancer outpatients, the authors describe the ESAS and PPS scores and their relation to patient characteristics. METHODS. This is a descriptive study using administrative healthcare data. RESULTS. The cohort included 45,118 and 23,802 patients' first ESAS and PPS, respectively. Fatigue was most prevalent (75%), and nausea least prevalent (25%) in the cohort. More than half of patients reported pain or shortness of breath; about half of those reported moderate to severe scores. Seventy-eight percent had stable performance status scores. On multivariate analysis, worse ESAS outcomes were consistently seen for women, those with comorbidity, and those with shorter survivals from assessment. Lung cancer patients had the worst burden of symptoms. CONCLUSIONS. This is the first study to report ESAS and PPS scores in a large, geographically based cohort with a full scope of cancer diagnoses, including patients seen earlier in the cancer trajectory (ie, treated for cure). In this ambulatory cancer population, the high prevalence of numerous symptoms parallels those reported in palliative populations and represents a target for improved clinical care. Differences in outcomes for subgroups require further investigation. This research sets the groundwork for future research on patient and provider outcomes using linked administrative healthcare data. Cancer 2010;116:5767-76.

Do High Symptom Scores Trigger Clinical Actions? An Audit After Implementing Electronic Symptom Screening

“…The study focused on pain and shortness of breath because they are prevalent in patients with lung and breast cancer and have been well studied using ESAS in other research. [13][14][15][16][17] Of note, in Ontario, unlike in the United States, cancer pain is not measured as a fifth vital sign or as part of routine care. 18 Cancer diagnoses were taken from the cancer center's electronic administrative database.…”

“…Previous research showed that ESAS scores in the Ontario cancer population were heavily skewed toward 0, with approximately half of ESAS assessments reporting 0 scores for pain and shortness of breath, respectively, and approximately 10% reporting scores of 7-10. 17 Following methods used in prior research, the ESAS symptoms were categorized into four categories of severity: none (0 score), mild (1 to 3 score), moderate (4 to 6 score) and severe (7-10 score), where scores of Ͼ 4 indicate clinically significant symptom issues. 24,25 To ensure adequate sample size in each of the ESAS categories by cancer type and symptom, we chose a stratified sampling method.…”

The Impact of Cancer Treatment on the Diets and Food Preferences of Patients Receiving Outpatient Treatment

“…Most patients diagnosed with cancer will receive treatment, and patients undergoing treatment experience a multitude of symptoms, including fatigue, pain, difficulty breathing, nausea, appetite loss, and unintentional weight change (2)(3)(4)(5). These symptoms can negatively impact one's ability to complete treatment as well as one's quality of life during and after treatment (6)(7)(8)(9)(10)(11).…”

Quality of End-of-Life Cancer Care in Canada: A Retrospective Four-Province Study Using Administrative Health Care Data

“…In particular, it aims to enhance quality of life at the end of life (eol) 1 . Without effective health care interventions, many cancer patients have uncontrolled symptoms, poor quality of life, and unnecessary suffering [2][3][4][5][6][7][8][9] . The literature suggests that, over time, cancer care is becoming more aggressive near the eol 10,11 .…”