University of Oklahoma Health Sciences Center, Oklahoma City, OK
Anh B. Lam , Debra Lundquist , Andrea Pelletier , Sienna Durbin , Laura A Petrillo , Rachel Jimenez , Victoria Turbini , Viola Bame , Kaitlyn Lynch , Mary Catherine Boulanger , Cynthia Moore , Vaishnavi Yalala , Nicholas Ollila , Benjamin Malowitz , Casandra McIntyre , Dejan Juric , Ryan David Nipp
Background: Individuals with cancer often endure a substantial physical and psychological symptom burden. However, little is known about the baseline symptom burden of patients with cancer participating in EP-CTs or the associations of this symptom burden with other PROs and clinical outcomes. Methods: We prospectively enrolled adults with cancer participating in EP-CTs at Massachusetts General Hospital from 4/2021-1/2023. Participants completed baseline surveys prior to EP-CT initiation that assessed symptoms (Edmonton Symptom Assessment System [ESAS]), quality of life (QOL; Functional Assessment of Cancer Therapy-General), hope (Herth Hope Index), depression/anxiety symptoms (Patient Health Questionnaire-4 [PHQ-4]), and financial wellbeing (COST tool, higher scores indicate greater financial wellbeing). We used regression models to explore associations of baseline symptom burden with other PROs (QOL, hope, depression/anxiety, financial wellbeing) and clinical outcomes (time on trial, hospitalizations, overall survival). Results: Among 205 participants (median age=63.3 [range: 31.8-88.6], 57.1% female), the most common cancer types were gastrointestinal (34.6%), breast (20.0%), and head and neck (10.2%). Based on the ESAS, approximately half of participants reported moderate/severe fatigue (50.2%) and poor wellbeing (49.5%). Under half reported moderate/severe drowsiness (35.7%), pain (25.9%), lack of appetite (25.4%), shortness of breath (20.0%), anxiety (18.0%), depression (15.4%), and nausea (9.2%). Higher baseline ESAS total, physical, and psychological scores were associated with worse QOL, lower hope, greater PHQ-4 depression/anxiety symptoms, and worse financial wellbeing (see Table). Higher baseline ESAS scores were associated with decreased time on trial and worse overall survival (see Table). Conclusions: In this study of EP-CT participants, we found associations of baseline symptom burden with other important PROs and clinical outcomes. Specifically, higher baseline symptom burden was associated with decreased QOL, lower hope, increased depression/anxiety symptoms, and diminished financial wellbeing as well as greater risk for shorter time on trial and worse survival. Interventions seeking to enhance care delivery and outcomes for EP-CT participants should strive to address the symptom burden of this population.
Outcomes | ESAS Total | ESAS Physical | ESAS Psychological | |||
---|---|---|---|---|---|---|
PROs | Beta | P | Beta | P | Beta | P |
QOL | -0.55 | <0.001 | -0.68 | <0.001 | -1.93 | <0.001 |
Hope | -0.10 | <0.001 | -0.09 | <0.001 | -0.53 | <0.001 |
PHQ-4 Depression/Anxiety | 0.06 | <0.001 | 0.06 | <0.001 | 0.39 | <0.001 |
Financial Wellbeing | -0.13 | 0.003 | -0.16 | 0.009 | -0.36 | 0.032 |
Clinical Outcomes | HR | P | HR | P | HR | P |
Hospitalizations | 1.01 | 0.066 | 1.02 | 0.059 | 1.03 | 0.290 |
Time on Trial | 1.01 | 0.069 | 1.01 | 0.208 | 1.04 | 0.046 |
Overall Survival | 1.02 | <0.001 | 1.03 | <0.001 | 1.04 | 0.088 |
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Abstract Disclosures
2024 ASCO Annual Meeting
First Author: Debra Lundquist
2022 ASCO Quality Care Symposium
First Author: Debra Lundquist
2022 ASCO Annual Meeting
First Author: Debra Lundquist
2023 ASCO Annual Meeting
First Author: Debra Lundquist