PROs Show High Symptom Burden Among Newly Diagnosed Patients With Cancer

March 2, 2018

Earlier collection of patient-reported outcomes could potentially improve comprehensive cancer care.

Clinically significant symptoms were highly prevalent among patients with newly diagnosed cancer of all sites, according to a retrospective studypublished in the Journal of Clinical Oncology.

According to Lev D. Bubis, of the University of Toronto, and colleagues, this emphasizes the need for collection of patient-reported outcomes (PROs) among all patients with cancer and not just those with advanced disease.

“Routine collection of patient-reported outcomes can identify patients who experience suboptimal outcomes and may serve as a means of ongoing quality assessment of supportive care,” they wrote. “This study illustrates the feasibility of linking routinely collected PROs to large population-based health care databases.”

Bubis and colleagues conducted this study to evaluate symptom burden among patients with newly diagnosed cancer and to identify which patients may be at increased risk for elevated symptom burden. The retrospective observational study looked at data from 120,745 patients who were diagnosed with cancer between January 2007 and December 2014. All patients had survived at least 1 year from diagnosis. The researchers looked at patient-reported Edmonton Symptom Assessment System scores and linked those to provincial administrative healthcare data.

Of the included patients, the majority had cancers of the breast, gastrointestinal system, and respiratory system. The majority of patients included had at least one moderate-to-severe score for tiredness and well-being during the study period.

“The proportion of patients who reported moderate-to-severe scores changed over time for most cancer sites and symptoms,” the researchers noted. “For example, across cancer sites during the 1 to 2 months after diagnosis, a large proportion of patients reported elevated anxiety scores; however, this percentage decreased until month 6, when it became stable.

The researchers found variance of reporting moderate-to-severe scores across disease site and by patient characteristic. Patients with respiratory or oropharyngeal cancers had the highest incidence of moderate-to-severe scores across all symptoms, whereas those with genitourinary cancers had the lowest incidence. In addition, patients with oropharyngeal cancers had the highest odds of elevated scores for appetite (odds ratio [OR] = 3.17) and nausea (OR = 3.17). In contrast, patients with respiratory cancer had the highest odds of elevated scores for shortness of breath (OR = 4.13).

Looking at the data, the researchers observed two trends.

“The odds of moderate-to-severe scores for anxiety, depression, pain, dyspnea, well-being, and appetite decreased significantly in each successive month compared with the month of diagnosis,” they wrote. “Conversely, for nausea, tiredness, and drowsiness, the odds of moderate-to-severe scores were higher in months 2 to 8 compared with the month of diagnosis, with a return to baseline or lower in months 9 to 12.”

According to the researchers, these results show that earlier collection of patient-reported outcomes could have the potential to improve comprehensive cancer care.