Loading…
Province‐Wide Analysis of Patient‐Reported Outcomes for Stage IV Non‐Small Cell Lung Cancer
Background In Ontario, Canada, patient‐reported outcome (PRO) evaluation through the Edmonton Symptom Assessment System (ESAS) has been integrated into clinical workflow since 2007. As stage IV non‐small cell lung cancer (NSCLC) is associated with substantial disease and treatment‐related morbidity,...
Saved in:
| Published in: | The oncologist (Dayton, Ohio) Ohio), 2021-10, Vol.26 (10), p.e1800-e1811 |
|---|---|
| Main Authors: | , , , , , , , , , , , , , , , |
| Format: | Article |
| Language: | English |
| Subjects: | |
| Citations: | Items that this one cites Items that cite this one |
| Online Access: | Get full text |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| cited_by | cdi_FETCH-LOGICAL-c4870-8cccf9ab3f3fbed9e559736639b194f3cdf5788334f986dc07eca3b22826b83e3 |
|---|---|
| cites | cdi_FETCH-LOGICAL-c4870-8cccf9ab3f3fbed9e559736639b194f3cdf5788334f986dc07eca3b22826b83e3 |
| container_end_page | e1811 |
| container_issue | 10 |
| container_start_page | e1800 |
| container_title | The oncologist (Dayton, Ohio) |
| container_volume | 26 |
| creator | Tjong, Michael C. Doherty, Mark Tan, Hendrick Chan, Wing C. Zhao, Haoyu Hallet, Julie Darling, Gail Kidane, Biniam Wright, Frances C. Mahar, Alyson Davis, Laura E. Delibasic, Victoria Parmar, Ambika Mittmann, Nicole Coburn, Natalie G. Louie, Alexander V. |
| description | Background
In Ontario, Canada, patient‐reported outcome (PRO) evaluation through the Edmonton Symptom Assessment System (ESAS) has been integrated into clinical workflow since 2007. As stage IV non‐small cell lung cancer (NSCLC) is associated with substantial disease and treatment‐related morbidity, this province‐wide study investigated moderate to severe symptom burden in this population.
Materials and Methods
ESAS collected from patients with stage IV NSCLC diagnosed between 2007 and 2018 linked to the Ontario provincial health care system database were studied. ESAS acquired within 12 months following diagnosis were analyzed and the proportion reporting moderate to severe scores (ESAS ≥4) in each domain was calculated. Predictors of moderate to severe scores were identified using multivariable Poisson regression models with robust error variance.
Results
Of 22,799 patients, 13,289 (58.3%) completed ESAS (84,373 assessments) in the year following diagnosis. Patients with older age, with high comorbidity, and not receiving active cancer therapy had lower ESAS completion. The majority (94.4%) reported at least one moderate to severe symptom. The most prevalent were tiredness (84.1%), low well‐being (80.7%), low appetite (71.7%), and shortness of breath (67.8%). Most symptoms peaked at diagnosis and, while declining, remained high in the following year. On multivariable analyses, comorbidity, low income, nonimmigrants, and urban residency were associated with moderate to severe symptoms. Moderate to severe scores in all ESAS domains aside from anxiety were associated with radiotherapy within 2 weeks prior, whereas drowsiness, low appetite and well‐being, nausea, and tiredness were associated with systemic therapy within 2 weeks prior.
Conclusion
This province‐wide PRO analysis showed moderate to severe symptoms were prevalent and persistent among patients with metastatic NSCLC, underscoring the need to address supportive measures in this population especially around treatments.
Implications for Practice
In this largest study of lung cancer patient‐reported outcomes (PROs), stage IV non‐small cell lung cancer patients had worse moderate‐to‐severe symptoms than other metastatic malignancies such as breast or gastrointestinal cancers when assessed with similar methodology. Prevalence of moderate‐to‐severe symptoms peaked early and remained high during the first year of follow‐up. Symptom burden was associated with recent radiation and systemic treatments. Earl |
| doi_str_mv | 10.1002/onco.13890 |
| format | article |
| fullrecord | <record><control><sourceid>gale_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8488785</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A780547286</galeid><sourcerecordid>A780547286</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4870-8cccf9ab3f3fbed9e559736639b194f3cdf5788334f986dc07eca3b22826b83e3</originalsourceid><addsrcrecordid>eNp9kd1qFDEUx4Mo9kNvfAAJeCfMmkwyM8mNsAxaC0u3WL_uQiZzskZmkiWZreydj-Az-iRNO7a0IBI4OeT8zj_n8EfoBSULSkj5JngTFpQJSR6hQ1pxWXBJvj3OORGsaGglD9BRSj8IySkrn6IDxktac1odIn0ew6XzBv78-v3V9YCXXg_75BIOFp_ryYGfcukjbEOcoMfr3WTCCAnbEPHFpDeAT7_gs-AzdDHqYcAt5LDa-Q1uddaNz9ATq4cEz__ex-jz-3ef2g_Fan1y2i5XheGiIYUwxlipO2aZ7aCXUFWyYXXNZEclt8z0tmqEYIxbKerekAaMZl1ZirLuBAN2jN7OuttdN0Jv8uBRD2ob3ajjXgXt1MOKd9_VJlwqwYVoRJUFXs0CGz2Act6GjJnRJaOWjSAVb0pRZ2rxDyqfHkZnggfr8vuDhtdzg4khpQj2biRK1LV_6to_deNfhl_eX-IOvTUsA3QGfuZv9v-RUuuzdj2LXgFtO6kc</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Province‐Wide Analysis of Patient‐Reported Outcomes for Stage IV Non‐Small Cell Lung Cancer</title><source>Open Access: PubMed Central</source><source>EZB Electronic Journals Library</source><creator>Tjong, Michael C. ; Doherty, Mark ; Tan, Hendrick ; Chan, Wing C. ; Zhao, Haoyu ; Hallet, Julie ; Darling, Gail ; Kidane, Biniam ; Wright, Frances C. ; Mahar, Alyson ; Davis, Laura E. ; Delibasic, Victoria ; Parmar, Ambika ; Mittmann, Nicole ; Coburn, Natalie G. ; Louie, Alexander V.</creator><creatorcontrib>Tjong, Michael C. ; Doherty, Mark ; Tan, Hendrick ; Chan, Wing C. ; Zhao, Haoyu ; Hallet, Julie ; Darling, Gail ; Kidane, Biniam ; Wright, Frances C. ; Mahar, Alyson ; Davis, Laura E. ; Delibasic, Victoria ; Parmar, Ambika ; Mittmann, Nicole ; Coburn, Natalie G. ; Louie, Alexander V.</creatorcontrib><description>Background
In Ontario, Canada, patient‐reported outcome (PRO) evaluation through the Edmonton Symptom Assessment System (ESAS) has been integrated into clinical workflow since 2007. As stage IV non‐small cell lung cancer (NSCLC) is associated with substantial disease and treatment‐related morbidity, this province‐wide study investigated moderate to severe symptom burden in this population.
Materials and Methods
ESAS collected from patients with stage IV NSCLC diagnosed between 2007 and 2018 linked to the Ontario provincial health care system database were studied. ESAS acquired within 12 months following diagnosis were analyzed and the proportion reporting moderate to severe scores (ESAS ≥4) in each domain was calculated. Predictors of moderate to severe scores were identified using multivariable Poisson regression models with robust error variance.
Results
Of 22,799 patients, 13,289 (58.3%) completed ESAS (84,373 assessments) in the year following diagnosis. Patients with older age, with high comorbidity, and not receiving active cancer therapy had lower ESAS completion. The majority (94.4%) reported at least one moderate to severe symptom. The most prevalent were tiredness (84.1%), low well‐being (80.7%), low appetite (71.7%), and shortness of breath (67.8%). Most symptoms peaked at diagnosis and, while declining, remained high in the following year. On multivariable analyses, comorbidity, low income, nonimmigrants, and urban residency were associated with moderate to severe symptoms. Moderate to severe scores in all ESAS domains aside from anxiety were associated with radiotherapy within 2 weeks prior, whereas drowsiness, low appetite and well‐being, nausea, and tiredness were associated with systemic therapy within 2 weeks prior.
Conclusion
This province‐wide PRO analysis showed moderate to severe symptoms were prevalent and persistent among patients with metastatic NSCLC, underscoring the need to address supportive measures in this population especially around treatments.
Implications for Practice
In this largest study of lung cancer patient‐reported outcomes (PROs), stage IV non‐small cell lung cancer patients had worse moderate‐to‐severe symptoms than other metastatic malignancies such as breast or gastrointestinal cancers when assessed with similar methodology. Prevalence of moderate‐to‐severe symptoms peaked early and remained high during the first year of follow‐up. Symptom burden was associated with recent radiation and systemic treatments. Early and sustained PRO collection is important to detect actionable symptom progression, especially around treatments. Vulnerable patients (e.g., older, high comorbidity) who face barriers in attending in‐person clinic visits had lower PRO completion. Virtual PRO collection may improve completion.
Reporting a study in Canada, this article analyzes utilization of patient‐reported outcomes and symptom burden among patients with stage IV non‐small cell lung cancer, providing a basis for the development of strategies to address gaps in symptom management in this patient population.</description><identifier>ISSN: 1083-7159</identifier><identifier>EISSN: 1549-490X</identifier><identifier>DOI: 10.1002/onco.13890</identifier><identifier>PMID: 34216415</identifier><language>eng</language><publisher>Hoboken, USA: John Wiley & Sons, Inc</publisher><subject>Aged ; Carcinoma, Non-Small-Cell Lung - epidemiology ; Carcinoma, Non-Small-Cell Lung - therapy ; Diagnosis ; Distribution ; Edmonton Symptom Assessment System ; Humans ; Lung Cancer ; Lung cancer, Non-small cell ; Lung Neoplasms - epidemiology ; Lung Neoplasms - therapy ; Neoplasms ; Non‐small cell lung cancer ; Ontario - epidemiology ; Palliative Care ; Patient outcomes ; Patient Reported Outcome Measures ; Patient‐reported outcomes ; Retrospective Studies ; Stage IV ; Symptom Assessment ; Symptom burden</subject><ispartof>The oncologist (Dayton, Ohio), 2021-10, Vol.26 (10), p.e1800-e1811</ispartof><rights>2021 AlphaMed Press.</rights><rights>COPYRIGHT 2021 Oxford University Press</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4870-8cccf9ab3f3fbed9e559736639b194f3cdf5788334f986dc07eca3b22826b83e3</citedby><cites>FETCH-LOGICAL-c4870-8cccf9ab3f3fbed9e559736639b194f3cdf5788334f986dc07eca3b22826b83e3</cites><orcidid>0000-0002-3252-1965</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8488785/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8488785/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,315,733,786,790,891,27957,27958,53827,53829</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34216415$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tjong, Michael C.</creatorcontrib><creatorcontrib>Doherty, Mark</creatorcontrib><creatorcontrib>Tan, Hendrick</creatorcontrib><creatorcontrib>Chan, Wing C.</creatorcontrib><creatorcontrib>Zhao, Haoyu</creatorcontrib><creatorcontrib>Hallet, Julie</creatorcontrib><creatorcontrib>Darling, Gail</creatorcontrib><creatorcontrib>Kidane, Biniam</creatorcontrib><creatorcontrib>Wright, Frances C.</creatorcontrib><creatorcontrib>Mahar, Alyson</creatorcontrib><creatorcontrib>Davis, Laura E.</creatorcontrib><creatorcontrib>Delibasic, Victoria</creatorcontrib><creatorcontrib>Parmar, Ambika</creatorcontrib><creatorcontrib>Mittmann, Nicole</creatorcontrib><creatorcontrib>Coburn, Natalie G.</creatorcontrib><creatorcontrib>Louie, Alexander V.</creatorcontrib><title>Province‐Wide Analysis of Patient‐Reported Outcomes for Stage IV Non‐Small Cell Lung Cancer</title><title>The oncologist (Dayton, Ohio)</title><addtitle>Oncologist</addtitle><description>Background
In Ontario, Canada, patient‐reported outcome (PRO) evaluation through the Edmonton Symptom Assessment System (ESAS) has been integrated into clinical workflow since 2007. As stage IV non‐small cell lung cancer (NSCLC) is associated with substantial disease and treatment‐related morbidity, this province‐wide study investigated moderate to severe symptom burden in this population.
Materials and Methods
ESAS collected from patients with stage IV NSCLC diagnosed between 2007 and 2018 linked to the Ontario provincial health care system database were studied. ESAS acquired within 12 months following diagnosis were analyzed and the proportion reporting moderate to severe scores (ESAS ≥4) in each domain was calculated. Predictors of moderate to severe scores were identified using multivariable Poisson regression models with robust error variance.
Results
Of 22,799 patients, 13,289 (58.3%) completed ESAS (84,373 assessments) in the year following diagnosis. Patients with older age, with high comorbidity, and not receiving active cancer therapy had lower ESAS completion. The majority (94.4%) reported at least one moderate to severe symptom. The most prevalent were tiredness (84.1%), low well‐being (80.7%), low appetite (71.7%), and shortness of breath (67.8%). Most symptoms peaked at diagnosis and, while declining, remained high in the following year. On multivariable analyses, comorbidity, low income, nonimmigrants, and urban residency were associated with moderate to severe symptoms. Moderate to severe scores in all ESAS domains aside from anxiety were associated with radiotherapy within 2 weeks prior, whereas drowsiness, low appetite and well‐being, nausea, and tiredness were associated with systemic therapy within 2 weeks prior.
Conclusion
This province‐wide PRO analysis showed moderate to severe symptoms were prevalent and persistent among patients with metastatic NSCLC, underscoring the need to address supportive measures in this population especially around treatments.
Implications for Practice
In this largest study of lung cancer patient‐reported outcomes (PROs), stage IV non‐small cell lung cancer patients had worse moderate‐to‐severe symptoms than other metastatic malignancies such as breast or gastrointestinal cancers when assessed with similar methodology. Prevalence of moderate‐to‐severe symptoms peaked early and remained high during the first year of follow‐up. Symptom burden was associated with recent radiation and systemic treatments. Early and sustained PRO collection is important to detect actionable symptom progression, especially around treatments. Vulnerable patients (e.g., older, high comorbidity) who face barriers in attending in‐person clinic visits had lower PRO completion. Virtual PRO collection may improve completion.
Reporting a study in Canada, this article analyzes utilization of patient‐reported outcomes and symptom burden among patients with stage IV non‐small cell lung cancer, providing a basis for the development of strategies to address gaps in symptom management in this patient population.</description><subject>Aged</subject><subject>Carcinoma, Non-Small-Cell Lung - epidemiology</subject><subject>Carcinoma, Non-Small-Cell Lung - therapy</subject><subject>Diagnosis</subject><subject>Distribution</subject><subject>Edmonton Symptom Assessment System</subject><subject>Humans</subject><subject>Lung Cancer</subject><subject>Lung cancer, Non-small cell</subject><subject>Lung Neoplasms - epidemiology</subject><subject>Lung Neoplasms - therapy</subject><subject>Neoplasms</subject><subject>Non‐small cell lung cancer</subject><subject>Ontario - epidemiology</subject><subject>Palliative Care</subject><subject>Patient outcomes</subject><subject>Patient Reported Outcome Measures</subject><subject>Patient‐reported outcomes</subject><subject>Retrospective Studies</subject><subject>Stage IV</subject><subject>Symptom Assessment</subject><subject>Symptom burden</subject><issn>1083-7159</issn><issn>1549-490X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9kd1qFDEUx4Mo9kNvfAAJeCfMmkwyM8mNsAxaC0u3WL_uQiZzskZmkiWZreydj-Az-iRNO7a0IBI4OeT8zj_n8EfoBSULSkj5JngTFpQJSR6hQ1pxWXBJvj3OORGsaGglD9BRSj8IySkrn6IDxktac1odIn0ew6XzBv78-v3V9YCXXg_75BIOFp_ryYGfcukjbEOcoMfr3WTCCAnbEPHFpDeAT7_gs-AzdDHqYcAt5LDa-Q1uddaNz9ATq4cEz__ex-jz-3ef2g_Fan1y2i5XheGiIYUwxlipO2aZ7aCXUFWyYXXNZEclt8z0tmqEYIxbKerekAaMZl1ZirLuBAN2jN7OuttdN0Jv8uBRD2ob3ajjXgXt1MOKd9_VJlwqwYVoRJUFXs0CGz2Act6GjJnRJaOWjSAVb0pRZ2rxDyqfHkZnggfr8vuDhtdzg4khpQj2biRK1LV_6to_deNfhl_eX-IOvTUsA3QGfuZv9v-RUuuzdj2LXgFtO6kc</recordid><startdate>202110</startdate><enddate>202110</enddate><creator>Tjong, Michael C.</creator><creator>Doherty, Mark</creator><creator>Tan, Hendrick</creator><creator>Chan, Wing C.</creator><creator>Zhao, Haoyu</creator><creator>Hallet, Julie</creator><creator>Darling, Gail</creator><creator>Kidane, Biniam</creator><creator>Wright, Frances C.</creator><creator>Mahar, Alyson</creator><creator>Davis, Laura E.</creator><creator>Delibasic, Victoria</creator><creator>Parmar, Ambika</creator><creator>Mittmann, Nicole</creator><creator>Coburn, Natalie G.</creator><creator>Louie, Alexander V.</creator><general>John Wiley & Sons, Inc</general><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-3252-1965</orcidid></search><sort><creationdate>202110</creationdate><title>Province‐Wide Analysis of Patient‐Reported Outcomes for Stage IV Non‐Small Cell Lung Cancer</title><author>Tjong, Michael C. ; Doherty, Mark ; Tan, Hendrick ; Chan, Wing C. ; Zhao, Haoyu ; Hallet, Julie ; Darling, Gail ; Kidane, Biniam ; Wright, Frances C. ; Mahar, Alyson ; Davis, Laura E. ; Delibasic, Victoria ; Parmar, Ambika ; Mittmann, Nicole ; Coburn, Natalie G. ; Louie, Alexander V.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4870-8cccf9ab3f3fbed9e559736639b194f3cdf5788334f986dc07eca3b22826b83e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Aged</topic><topic>Carcinoma, Non-Small-Cell Lung - epidemiology</topic><topic>Carcinoma, Non-Small-Cell Lung - therapy</topic><topic>Diagnosis</topic><topic>Distribution</topic><topic>Edmonton Symptom Assessment System</topic><topic>Humans</topic><topic>Lung Cancer</topic><topic>Lung cancer, Non-small cell</topic><topic>Lung Neoplasms - epidemiology</topic><topic>Lung Neoplasms - therapy</topic><topic>Neoplasms</topic><topic>Non‐small cell lung cancer</topic><topic>Ontario - epidemiology</topic><topic>Palliative Care</topic><topic>Patient outcomes</topic><topic>Patient Reported Outcome Measures</topic><topic>Patient‐reported outcomes</topic><topic>Retrospective Studies</topic><topic>Stage IV</topic><topic>Symptom Assessment</topic><topic>Symptom burden</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tjong, Michael C.</creatorcontrib><creatorcontrib>Doherty, Mark</creatorcontrib><creatorcontrib>Tan, Hendrick</creatorcontrib><creatorcontrib>Chan, Wing C.</creatorcontrib><creatorcontrib>Zhao, Haoyu</creatorcontrib><creatorcontrib>Hallet, Julie</creatorcontrib><creatorcontrib>Darling, Gail</creatorcontrib><creatorcontrib>Kidane, Biniam</creatorcontrib><creatorcontrib>Wright, Frances C.</creatorcontrib><creatorcontrib>Mahar, Alyson</creatorcontrib><creatorcontrib>Davis, Laura E.</creatorcontrib><creatorcontrib>Delibasic, Victoria</creatorcontrib><creatorcontrib>Parmar, Ambika</creatorcontrib><creatorcontrib>Mittmann, Nicole</creatorcontrib><creatorcontrib>Coburn, Natalie G.</creatorcontrib><creatorcontrib>Louie, Alexander V.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The oncologist (Dayton, Ohio)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tjong, Michael C.</au><au>Doherty, Mark</au><au>Tan, Hendrick</au><au>Chan, Wing C.</au><au>Zhao, Haoyu</au><au>Hallet, Julie</au><au>Darling, Gail</au><au>Kidane, Biniam</au><au>Wright, Frances C.</au><au>Mahar, Alyson</au><au>Davis, Laura E.</au><au>Delibasic, Victoria</au><au>Parmar, Ambika</au><au>Mittmann, Nicole</au><au>Coburn, Natalie G.</au><au>Louie, Alexander V.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Province‐Wide Analysis of Patient‐Reported Outcomes for Stage IV Non‐Small Cell Lung Cancer</atitle><jtitle>The oncologist (Dayton, Ohio)</jtitle><addtitle>Oncologist</addtitle><date>2021-10</date><risdate>2021</risdate><volume>26</volume><issue>10</issue><spage>e1800</spage><epage>e1811</epage><pages>e1800-e1811</pages><issn>1083-7159</issn><eissn>1549-490X</eissn><notes>For permission information contact</notes><notes>permissions@wiley.com</notes><notes>commercialreprints@wiley.com</notes><notes>.</notes><notes>Disclosures of potential conflicts of interest may be found at the end of this article</notes><notes>No part of this article may be reproduced, stored, or transmitted in any form or for any means without the prior permission in writing from the copyright holder. For information on purchasing reprints contact</notes><notes>Disclosures of potential conflicts of interest may be found at the end of this article.</notes><notes>No part of this article may be reproduced, stored, or transmitted in any form or for any means without the prior permission in writing from the copyright holder. For information on purchasing reprints contact commercialreprints@wiley.com. For permission information contact permissions@wiley.com.</notes><abstract>Background
In Ontario, Canada, patient‐reported outcome (PRO) evaluation through the Edmonton Symptom Assessment System (ESAS) has been integrated into clinical workflow since 2007. As stage IV non‐small cell lung cancer (NSCLC) is associated with substantial disease and treatment‐related morbidity, this province‐wide study investigated moderate to severe symptom burden in this population.
Materials and Methods
ESAS collected from patients with stage IV NSCLC diagnosed between 2007 and 2018 linked to the Ontario provincial health care system database were studied. ESAS acquired within 12 months following diagnosis were analyzed and the proportion reporting moderate to severe scores (ESAS ≥4) in each domain was calculated. Predictors of moderate to severe scores were identified using multivariable Poisson regression models with robust error variance.
Results
Of 22,799 patients, 13,289 (58.3%) completed ESAS (84,373 assessments) in the year following diagnosis. Patients with older age, with high comorbidity, and not receiving active cancer therapy had lower ESAS completion. The majority (94.4%) reported at least one moderate to severe symptom. The most prevalent were tiredness (84.1%), low well‐being (80.7%), low appetite (71.7%), and shortness of breath (67.8%). Most symptoms peaked at diagnosis and, while declining, remained high in the following year. On multivariable analyses, comorbidity, low income, nonimmigrants, and urban residency were associated with moderate to severe symptoms. Moderate to severe scores in all ESAS domains aside from anxiety were associated with radiotherapy within 2 weeks prior, whereas drowsiness, low appetite and well‐being, nausea, and tiredness were associated with systemic therapy within 2 weeks prior.
Conclusion
This province‐wide PRO analysis showed moderate to severe symptoms were prevalent and persistent among patients with metastatic NSCLC, underscoring the need to address supportive measures in this population especially around treatments.
Implications for Practice
In this largest study of lung cancer patient‐reported outcomes (PROs), stage IV non‐small cell lung cancer patients had worse moderate‐to‐severe symptoms than other metastatic malignancies such as breast or gastrointestinal cancers when assessed with similar methodology. Prevalence of moderate‐to‐severe symptoms peaked early and remained high during the first year of follow‐up. Symptom burden was associated with recent radiation and systemic treatments. Early and sustained PRO collection is important to detect actionable symptom progression, especially around treatments. Vulnerable patients (e.g., older, high comorbidity) who face barriers in attending in‐person clinic visits had lower PRO completion. Virtual PRO collection may improve completion.
Reporting a study in Canada, this article analyzes utilization of patient‐reported outcomes and symptom burden among patients with stage IV non‐small cell lung cancer, providing a basis for the development of strategies to address gaps in symptom management in this patient population.</abstract><cop>Hoboken, USA</cop><pub>John Wiley & Sons, Inc</pub><pmid>34216415</pmid><doi>10.1002/onco.13890</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0002-3252-1965</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1083-7159 |
| ispartof | The oncologist (Dayton, Ohio), 2021-10, Vol.26 (10), p.e1800-e1811 |
| issn | 1083-7159 1549-490X |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8488785 |
| source | Open Access: PubMed Central; EZB Electronic Journals Library |
| subjects | Aged Carcinoma, Non-Small-Cell Lung - epidemiology Carcinoma, Non-Small-Cell Lung - therapy Diagnosis Distribution Edmonton Symptom Assessment System Humans Lung Cancer Lung cancer, Non-small cell Lung Neoplasms - epidemiology Lung Neoplasms - therapy Neoplasms Non‐small cell lung cancer Ontario - epidemiology Palliative Care Patient outcomes Patient Reported Outcome Measures Patient‐reported outcomes Retrospective Studies Stage IV Symptom Assessment Symptom burden |
| title | Province‐Wide Analysis of Patient‐Reported Outcomes for Stage IV Non‐Small Cell Lung Cancer |
| url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-09-21T21%3A42%3A04IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Province%E2%80%90Wide%20Analysis%20of%20Patient%E2%80%90Reported%20Outcomes%20for%20Stage%20IV%20Non%E2%80%90Small%20Cell%20Lung%20Cancer&rft.jtitle=The%20oncologist%20(Dayton,%20Ohio)&rft.au=Tjong,%20Michael%20C.&rft.date=2021-10&rft.volume=26&rft.issue=10&rft.spage=e1800&rft.epage=e1811&rft.pages=e1800-e1811&rft.issn=1083-7159&rft.eissn=1549-490X&rft_id=info:doi/10.1002/onco.13890&rft_dat=%3Cgale_pubme%3EA780547286%3C/gale_pubme%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c4870-8cccf9ab3f3fbed9e559736639b194f3cdf5788334f986dc07eca3b22826b83e3%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_id=info:pmid/34216415&rft_galeid=A780547286&rfr_iscdi=true |