Self-reported overall wellbeing and physical function among chemotherapy and surgery patients completing symptom questionnaires across six health systems.

Authors

null

Michael J. Hassett

Dana-Farber Cancer Institute, Boston, MA

Michael J. Hassett , Christine Cronin , Angela Tramontano , Sandra L. Wong , Hajime Uno , Roshan Paudel , Jessica J Bian , Don S. Dizon , Hannah W. Hazard-Jenkins , Raymond U. Osarogiagbon , Deborah Schrag

Organizations

Dana-Farber Cancer Institute, Boston, MA, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, Dartmouth-Hitchcock Medical Center, Lebanon, NH, MaineHealth Cancer Care, South Portland, ME, Lifespan Cancer Institute, Rhode Island Hospital, Providence, RI, WVU Cancer Institute, West Virginia University, Morgantown, WV, Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, Memorial Sloan Kettering Cancer Center, New York, NY

Research Funding

U.S. National Institutes of Health
U.S. National Institutes of Health

Background: Health systems have begun using electronic patient reported outcomes (ePROs) to evaluate and ideally mitigate patients’ symptom burden following treatment for cancer and other conditions. However, the optimal number of symptoms and approach to capturing this information is unknown. We hypothesized that self-reported overall wellbeing (OWB) and physical function (PFN) would provide distinctive information, beyond that described by a multi-item symptom questionnaire, and augment the clinical utility of an ePRO system. Methods: eSyM, an EHR-integrated symptom management program, was deployed across six health systems for patients receiving chemotherapy or surgery for a suspected or confirmed thoracic, gastrointestinal, or gynecologic malignancy. eSyM prompts patients to complete a 12-item symptom questionnaire 2-3 times per week. This questionnaire also includes two pictogram questions that assess OWB and PFN – each scored using a four-point scale from 0 (best) to 3 (worst). We sought to identify patient characteristics associated with the lowest OWB and PFN (i.e., score = 3), to describe Spearman correlations between OWB and PFN, and to elucidate the relationships between symptom scores and OWB/PFN. Ordinal logistic regression models were used to adjust for potential confounding. Results: From September 2019-December 2022, 9753 patients submitted 75,166 questionnaires. There were 3846 chemotherapy patients (median age 66, 58% female, 17% non-white) and 5907 surgery patients (median age 61, 73% female, 7% non-white). The plurality of responses indicated mild impairment for OWB and PFN (Table). OWB and PFN scores were moderately correlated with each other (chemotherapy 0.62; surgery 0.59); with the sum of all symptom scores for chemotherapy (OWB 0.48, PFN 0.45) and surgery (OWB 0.51, PFN 0.45) patients; and with pain, fatigue, and anorexia (correlation coefficients 0.40-0.61). No individual symptoms were strongly correlated (coefficient > 0.7) with OWB or PFN. After controlling for other factors, OWB and PFN scores varied significantly by health system. Patients with disability were more likely to report low OWB and PFN (ORs 1.99-3.26; p < 0.05) versus other employment statuses. Conclusions: In a large cohort of chemotherapy and surgery patients from six community-based cancer centers, self-reported OWB and PFN scores were moderately correlated with common symptoms. These items offer discriminant and face validity and provide distinctive information that supplements a multi-item symptom questionnaire. Routine use of OWB and PFN can guide management strategies for symptomatic cancer patients. Clinical trial information: NCT03850912.

Score (impairment)Chemotherapy (% of 3846 pts)Surgery (% of 5907 pts)
Overall Wellbeing0 (none)1729
1 (mild)4145
2 (moderate)3420
3 (severe)86
Physical Function0 (none)2432
1 (mild)4439
2 (moderate)1916
3 (severe)1313

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Abstract Details

Meeting

2023 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Symptoms and Survivorship

Track

Symptom Science and Palliative Care

Sub Track

Palliative Care and Symptom Management

Clinical Trial Registration Number

NCT03850912

Citation

J Clin Oncol 41, 2023 (suppl 16; abstr 12110)

DOI

10.1200/JCO.2023.41.16_suppl.12110

Abstract #

12110

Poster Bd #

478

Abstract Disclosures