Symptom clusters in cancer patients with bone metastases

Chow, Edward; Fan, Grace; Hadi, Stephanie; Filipczak, Linda A.

doi:10.1007/s00520-007-0241-z

Cited by 75 publications

(64 citation statements)

References 23 publications

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“…Comparing our results to studies that specifically report ESAS scores from a palliative care unit or clinic, 26,27,[31][32][33][34][35][36][37][38] the symptom prevalence and symptom scores from these palliative patients are consistently higher than in our study. For example, in a study of 1296 patients attending a palliative radiation oncology outpatient clinic, 26 the median symptom score was 5 for fatigue, 2 for dyspnea, 3 for pain, and 2 for depression compared with our results of 3, 0, 1, and 0, respectively.…”

Section: Sarcomasupporting

confidence: 56%

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

Barbera

Seow

Howell

et al. 2010

Cancer

193

128

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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.

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Section: Sarcomasupporting

confidence: 56%

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

Barbera

Seow

Howell

et al. 2010

Cancer

193

128

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“…PCA is statistical technique used in prior studies in patients with advanced cancer to examine the symptoms that correlate with each other to form a distinct and stable pattern, which is known as a component in the PCA model [45][46][47][48]. In 114 evaluable patients, the following three clusters accounted for 63% of the total variance: the fatigue/anorexia-cachexia/depression (FAD) cluster, the sleep/ anxiety/drowsiness (SAD) cluster, and the pain/dyspnea (PD)…”

Section: Discussionmentioning

confidence: 99%

Effects of Dexamethasone and Placebo on Symptom Clusters in Advanced Cancer Patients: A Preliminary Report

et al. 2016

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Objective. Advanced cancer patients frequently experience debilitating symptoms that occur in clusters, but few pharmacological studies have targeted symptom clusters. Our objective was to examine the effects of dexamethasone on symptom clusters in patients with advanced cancer. Methods. We reviewed the data from a previous randomized clinical trial to determine the effects of dexamethasone on cancer symptoms. Symptom clusters were identified according to baseline symptoms by using principal component analysis. Correlations and change in the severity of symptom clusters were analyzed after study treatment. Results. A total of 114 participants were included in this study. Three clusters were identified: fatigue/anorexia-cachexia/ depression (FAD), sleep/anxiety/drowsiness (SAD), and pain/dyspnea (PD). Changes in severity of FAD and PD significantly correlated over time (at baseline, day 8, and day 15). The FAD cluster was associated with significant improvement in severity at day 8 and day 15, whereas no significant change was observed with the SAD cluster or PD cluster after dexamethasone treatment. Conclusion. The results of this preliminary study suggest significant correlation over time and improvement in the FAD cluster at day 8 and day 15 after treatment with dexamethasone. These findings suggest that fatigue, anorexia-cachexia, and depression may share a common pathophysiologic basis. Further studies are needed to investigate this cluster and target anti-inflammatory therapies. The Oncologist 2016; 21:384-390Implications for Practice: Results of this preliminary study suggest that fatigue-anorexia/cachexia/depression cluster scores significantly improved in the dexamethasone treatment group as compared with placebo.These findings indicate that symptoms in the fatigue/anorexia-cachexia/depression cluster might share a common causative mechanism. Further studies are needed to validate these findings.

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“…More than 130 relevant articles and abstracts were identified, of which thirty-nine were primary studies published as complete peer-reviewed papers, representing 25 different institutions. Of the thirty-nine papers, thirteen were from Canada 6,11,[20][21][22][23][24][25][26][27][28][29][30] ; eight were from the United States [12][13][14]18,[31][32][33][34] ; eight were from Scandinavia (Sweden 15,[35][36][37] , Denmark [38][39] , Norway 40 , Finland 16 ); two were from Western Europe (Netherlands 41 , United Kingdom 42 ); five were from southern Europe (Switzerland 43 , Italy 17,[44][45][46] ); two were from Australia 47,48 ; and one was from Asia 49 .…”

Section: Methodsmentioning

confidence: 99%

“…Sample sizes in the thirty-three oncologic studies ranged from 32 to 1296 subjects, for a total in excess of 5000 patients. However, eleven of the thirty-three studies reported some data for the same patients: Sunnybrook Cancer Centre in Canada [25][26][27][28] , Bispebjerg Hospital in Denmark [38][39] , Linkoping Hospital in Sweden 15,35,36 , and Yale University 18,34 . For the patients described in the thirty-three papers, median age ranged from 53 to 74 years, and men were in a slight majority overall.…”

Section: Population Characteristicsmentioning

confidence: 99%

“…The overall distribution was perhaps typical of a palliative population. In the non-hospital but palliative context, most subjects were at home 17,18,22,[25][26][27][28][29][30]32,34,36,40,47 or at a hospice 48 . Overall, the "extreme" condition of the subjects is reflected in the descriptions provided in the papers themselves: disease was "advanced," patients were "terminally ill," symptoms were "moderate" to "severe" (justifying hospitalization), performance status was intermediate-to-low [median Karnofsky performance status (KPS): , and reduced cognitive functioning was present in some patients.…”

Section: Population Characteristicsmentioning

confidence: 99%

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A Review of the Reliability and Validity of the Edmonton Symptom Assessment System

2009

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BackgroundSystematic symptom reporting by patients and the use of questionnaires such as the Edmonton Symptom Assessment System (ESAS) have potential to improve clinical encounters and patient satisfaction. We review findings from published studies of the ESAS to guide use of the system and to focus research. MethodsA systematic search for articles from 1991 through 2007 found thirty-nine peer-reviewed papers from 25 different institutions, thirty-three of which focused on patients with cancer. Observations, data, and statistics were collated according to relevance, reliability, validity, and responsiveness. ResultsFindings apply predominantly to symptomatic palliative patients with advanced cancer who were no longer receiving active oncologic therapies. Uncertainty about summarizing findings arises from frequent modification of the ESAS (altered items, scales, and time periods). Overall, reliability is established for daily administration. Scores are skewed, with a floor effect, but the relative order of symptoms by mean scores is similar across studies. Emotional symptoms are poorly captured by the depression and anxiety items. An equally weighted summation of scores may estimate a construct of "physical symptom distress," which in turn is related to performance status, palliative goals, quality of life, and well-being. ConclusionsThe ESAS is reliable, but it has restricted validity, and its use requires a sound clinical process to help interpret scores and to give them an appropriate level of attention. Research priorities are to further develop the ESAS for assessing a greater number of important physical symptoms (and to target "physical symptom

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Symptom clusters in cancer patients with bone metastases

Cited by 75 publications

References 23 publications

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

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

Effects of Dexamethasone and Placebo on Symptom Clusters in Advanced Cancer Patients: A Preliminary Report

A Review of the Reliability and Validity of the Edmonton Symptom Assessment System

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