Tom Baker Cancer Center, Calgary, AB, Canada
Atul Batra , Colleen Ann Cuthbert , Andrew Harper , Lin Yang , Devon J. Boyne , Rodrigo Rigo , Winson Y. Cheung
Background: Patients with metastatic cancer experience variable symptom burden, but serial symptom assessments using PROs may be challenging to implement in routine clinical practices. We aimed to determine if a single measurement of symptom burden at the time of metastatic diagnosis is associated with survival. Methods: We examined prospectively collected baseline PROs of patients newly diagnosed with metastatic breast, lung, colorectal, or prostate cancer using the revised Edmonton Symptom Assessment System (ESASr) questionnaire from a large province (Alberta, Canada) between 2016 and 2019. The ESASr was categorized into physical (PH), psychosocial (PS), and total symptom (TS) domains whereby scores were classified as mild (0-3), moderate (4-6), or severe (7-10). Multivariable Cox proportional hazards models were constructed to evaluate the effect of baseline symptom scores on OS. Results: We identified 1,315 patients, of whom 57% were men and median age was 66 (IQR, 27-93) years. There were 180, 601, 240, and 294 patients with breast, lung, colorectal, and prostate cancer, respectively. Approximately one-quarter of all patients reported moderate to severe PH, PS, and TS scores, with lung cancer patients experiencing the highest symptom intensity across all domains (P<0.0001). While age did not affect symptom scores, women were more likely to report severe PH, PS, and TS scores as compared to men (P=0.02, 0.002, and 0.007, respectively). On multivariable Cox regression analysis, older age (HR 1.02, 95% CI, 1.02-1.03, P<0.0001) and female sex (HR 1.67, 95% CI, 1.39-1.99, P<0.0001) were predictive of worse OS as were severe baseline PH and TS scores (see Table) . However, baseline PS scores were not related to OS. Conclusions: A single assessment of baseline symptom burden using the ESASr in patients with metastatic cancer has significant prognostic value. This may represent a feasible first step toward routine collection of PROs in real-world settings where serial symptom measurements can be challenging to implement.
Group (n) | Median OS, in months (95% CI) | HR (95% CI) | P value |
---|---|---|---|
PH | |||
Mild (885) | 33.5 (30.2-36.4) | - | - |
Moderate (368) | 12.2 (10.1-15.1) | 1.68 (1.32-2.13) | <0.0001 |
Severe (62) | 10.8 (4.9-17.7) | 1.89 (1.26-2.83) | 0.002 |
PS | |||
Mild (946) | 29.1 (25.5-33.3) | - | - |
Moderate (243) | 16.1 (12.4-20.8) | 1.15 (0.94-1.41) | 0.17 |
Severe (117) | 10.7 (8.1-16.9) | 1.13 (0.85-1.52) | 0.39 |
TS | |||
Mild (924) | 32.5 (28.6-35.1) | - | - |
Moderate (350) | 12.2 (10.1-15.1) | 1.27 (0.96-1.68) | 0.09 |
Severe (41) | 7.9 (3.5-16.9) | 1.71 (1.01-2.91) | 0.04 |
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Abstract Disclosures
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