The effectiveness of a provincial symptom assessment program in reaching adolescents and young adults with cancer: A population‐based cohort study

Gupta, Sumit; Sutradhar, Rinku; Li, Qing; Coburn, Natalie

doi:10.1002/cam4.4401

Cited by 4 publications

(11 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…First, 21% of our cohort was not ESAS screened during a year of their cancer diagnosis. Past work has shown that these patients are more likely to live in low‐income urban neighborhoods or to have hematologic malignancies 26 . The symptom disparities we describe may thus be underestimated.…”

Section: Discussionmentioning

confidence: 74%

“…AYA residing in the poorest urban neighborhoods were more likely to experience moderate and severe symptoms compared to those in the wealthiest areas. This is of particular concern as previous work found that these same AYA were also less likely to complete ESAS scores at all 26 . Similarly, AYA in Northern Ontario experienced more severe symptoms than those in urban Toronto.…”

Section: Discussionmentioning

confidence: 85%

“…Populations who did not have access to ESAS were excluded: (1) diagnosis and treatment in pediatric institutions; (2) did not require services at a cancer center in the first year after diagnosis (e.g., surgically resected thyroid cancer, removal of colonic polyps), and; (3) the small number of AYA who were treated exclusively at non-RCCs. 26 Finally, AYA who were not screened with ESAS during the first year after their cancer diagnosis were excluded, as no descriptions of their symptom burden could be made.…”

Section: Study Population and Data Sourcesmentioning

confidence: 99%

See 2 more Smart Citations

Prevalence, severity, and predictors of symptom burden among adolescents and young adults with cancer

Gupta

Li²,

Nathan

et al. 2023

Cancer Medicine

Self Cite

View full text Add to dashboard Cite

Background Symptom burden in adolescents and young adults (AYA) with cancer is poorly characterized but impacts quality of life. Methods All Ontario, Canada AYA aged 15–29 years at diagnosis between 2010 and 2018 were linked to population‐based healthcare databases, including to Edmonton Symptom Assessment System‐revised (ESAS) scores, an 11‐point scale routinely obtained at the time of cancer‐related outpatient visits and collected provincially. Multistate models estimated mean duration of symptom severity states [none (0) vs. mild (1 vs. 2 vs. 3) vs. moderate (4–6) vs. severe (7–10)], trajectories, and subsequent mortality risk. Variables associated with severe symptoms were also determined. Results In total, 4296 AYA with ≥1 ESAS score within a year of diagnosis were included (median age 25 years). Prevalent moderate/severe symptoms included fatigue (59% of AYA) and anxiety (44%). Across symptom type, AYA reporting moderate symptoms were likelier to subsequently experience improvement versus worsening. Risk of death within 6 months increased with increasing symptom burden and was highest in AYA with severe dyspnea (9.0%), pain (8.0%), or drowsiness (7.5%). AYA in the poorest urban neighborhoods were more likely to experience severe symptoms than in the wealthiest areas, with twice the odds of reporting severe depression [adjusted odds ratio (OR) 1.95, 95th confidence interval (95% CI) 1.37–2.78], pain (OR: 1.94, 95% CI: 1.39–2.70), and dyspnea (OR: 1.96, 95% CI: 1.27–3.02). Conclusions AYA with cancer experience substantial symptom burden. Risk of death increased with symptom severity. Interventions targeting cancer fatigue and anxiety, and targeting AYA in lower‐income neighborhoods, are likely to improve quality of life in this population.

show abstract

Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 85%

Section: Study Population and Data Sourcesmentioning

confidence: 99%

See 1 more Smart Citation

Prevalence, severity, and predictors of symptom burden among adolescents and young adults with cancer

Gupta

Li²,

Nathan

et al. 2023

Cancer Medicine

Self Cite

View full text Add to dashboard Cite

show abstract

“…Inpatients are not screened. Symptom scores are collected centrally in the Symptom Management Reporting Database …”

Section: Methodsmentioning

confidence: 99%

“…We created a retrospective population-based cohort of AYAs who were aged 15 to 29 years at primary cancer diagnosis between January 1, 2010, and June 30, 2018, as identified through the Ontario Cancer Registry . Populations who did not have ESAS access were excluded if they (1) received treatment in pediatric institutions, (2) did not require services at a RCC in the first year after diagnosis (eg, surgically resected thyroid cancer), or (3) were treated exclusively at non-RCCs.…”

Section: Methodsmentioning

confidence: 99%

Specialty Palliative Care and Symptom Severity and Control in Adolescents and Young Adults With Cancer

Gupta,

Li,

Kassam

et al. 2023

JAMA Netw Open

Self Cite

View full text Add to dashboard Cite

ImportanceAdolescents and young adults (AYAs) with cancer experience substantial symptom burden. Specialty palliative care (SPC) is recommended but often not involved or involved late.ObjectivesTo determine whether patient-reported symptom severity was associated with subsequent SPC involvement and whether SPC was associated with symptom improvement in AYAs with cancer.Design, Setting, and ParticipantsThis cohort study comprised AYAs (aged 15-29 years) with primary cancer diagnosed between January 1, 2010, and June 30, 2018, in Ontario, Canada. Data, including self-reported Edmonton Symptom Assessment System (ESAS) scores, were obtained from health care databases. Specialty palliative care was identified through billing codes and validated algorithms. Final data analysis was performed on April 4, 2023.Main Outcomes and MeasuresAssociations of ESAS scores with subsequent SPC involvement were determined. A difference-in-differences approach was used for patients who died within 5 years of their cancer diagnosis. Case patients (SPC predeath, index date equals first SPC service) were matched 1:1 to control patients (no SPC at equivalent time before death). The study examined whether the difference between 90-day postindex and preindex mean ESAS scores was itself different between case and control patients.ResultsThis study included 5435 AYAs with cancer, with a median follow-up of 5.1 (IQR, 2.5-7.9) years for analyses of general palliative care. Their median age at cancer diagnosis was 25 (IQR, 22-27) years, and more than half were male (2809 [51.7%]). For all symptoms, moderate and severe ESAS scores were associated with an increased likelihood of SPC involvement compared with mild scores. The greatest magnitude of association was seen for pain scores (hazard ratio for severe vs mild, 7.7 [95% CI, 5.8-10.2]; P &lt; .001). A total of 721 AYAs (13.3%) died within 5 years of diagnosis, and 612 of these patients (84.9%) had received SPC before death. Among 202 case-control pairs, SPC involvement was associated with improved pain trajectories (mean scores improved from 3.41 to 3.07 in case patients and worsened from 1.86 to 2.16 in control patients; P = .003). Other symptom trajectories were not affected.Conclusions and RelevanceIn this cohort study of AYAs with cancer, those reporting moderate or severe symptoms through a screening program were more likely to subsequently receive SPC. These findings suggest that SPC was associated with a subsequent decrease in pain severity but did not affect other symptoms. New interventions targeting other symptoms during treatment and particularly at the end of life are needed.

show abstract