Symptom Burden: Multiple Symptoms and Their Impact as Patient-Reported Outcomes

2007 ◽  
Vol 2007 (37) ◽  
pp. 16-21 ◽  
Author(s):  
C. S. Cleeland
Keyword(s):  
Patient Reported Outcomes ◽  
Symptom Burden ◽  
Patient Reported ◽  
Multiple Symptoms

scholarly journals P1.10-005 Generation of Symptom Burden Patient-Reported Outcomes for Patients with Lung Cancer

2017 ◽  
Vol 12 (11) ◽  
pp. S2024
Author(s):  
L. Williams ◽  
C. Cleeland ◽  
O. Bamidele ◽  
G. Simon
Keyword(s):  
Lung Cancer ◽  
Patient Reported Outcomes ◽  
Symptom Burden ◽  
Patient Reported

Patient reported outcomes in patients with desmoid type fibromatosis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 11574-11574
Author(s):  
VIKAS GARG ◽  
Sameer Rastogi ◽  
Adarsh Barwad ◽  
Rambha Panday ◽  
Sandeep Kumar Bhoriwal ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Symptom Burden ◽  
Benign Neoplasm ◽  
Anxiety And Depression ◽  
Appendicular Skeleton ◽  
Healthy Controls ◽  
Symptom Scale ◽  
Cross Sectional ◽  
Patient Reported ◽  
The Impact

11574 Background: Desmoid type fibromatosis (DTF) is a rare benign neoplasm with infiltrative growth and high local recurrences. Due to long disease course, unpredictable growth pattern, and low mortality, using only survival outcomes may be inappropriate. In this study we assessed the impact of DTF on health related quality of life (HRQoL). Methods: This was a cross-sectional study done in patients with DTF. The study participants were asked to fill the EORTC QLQ-C30, GAD-7 and PHQ- 9 q uestionnaires to assess HRQoL, anxiety and depression . Outcomes were also compared with healthy controls. Results: 204 subjects (102 DTF patients and 102 healthy controls) were recruited. Study parameters have been summarized in Table. Appendicular skeleton (limbs + girdle) was most commonly involved in 59 % patients and abdominal wall or mesentery was involved in 22.5 %. Patients have received median of 2 lines of therapy. 54 % patients were currently on sorafenib and 41 % were under active surveillance. Mean global health status in DTF patient 65.58 ± 22.64, was significantly lower than healthy controls. Similarly, DTF patients scored low on all functional scales except cognitive functioning. Symptom scale showed significantly higher symptom burden of fatigue, pain, insomnia and financial difficulties. Anxiety & depression was observed in 39.22 % and 50 % of DTF patients respectively. DTF patients had higher rates of mild, moderate and severe anxiety and depression compared to healthy controls. No difference was observed based on site of disease. Conclusions: DTF patients have significant symptom burden, poor functioning, and heightened anxiety and depression. Patient reported outcomes should be routinely used to assess treatment efficacy in DTF patients.[Table: see text]

Impact of a tiered discharge opioid algorithm on prescriptions and patient-reported outcomes after open gynecologic surgery

2021 ◽  
pp. ijgc-2021-002674
Author(s):  
Sarah Huepenbecker ◽  
Robert Tyler Hillman ◽  
Maria D Iniesta ◽  
Tsun Chen ◽  
Katherine Cain ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Enhanced Recovery ◽  
Symptom Burden ◽  
Equivalent Dose ◽  
Hospital Length Of Stay ◽  
Gynecologic Surgery ◽  
Post Discharge ◽  
Opioid Prescribing ◽  
Patient Reported ◽  
Morphine Equivalent

ObjectiveTo compare discharge opioid refills, prescribed morphine equivalent dose and quantity, and longitudinal patient-reported outcomes before and after implementation of a tiered opioid prescribing algorithm among women undergoing open gynecologic surgery within an enhanced recovery after surgery program.MethodsWe compared opioid prescriptions, clinical outcomes, and patient-reported outcomes among 273 women. Post-discharge symptom burden was collected up to 42 days after discharge using the validated 27-item MD Anderson Symptom Inventory and analyzed using linear mixed effects models and Kaplan–Meier curves for symptom recovery.ResultsAmong 113 pre-implementation and 160 post-implementation patients there was no difference in opioid refills (9.7% vs 11.3%, p=0.84). The post-implementation cohort had a significant reduction in median morphine equivalent dose (112.5 mg vs 225 mg, p<0.01), with no difference in median hospital length of stay (3 days vs 3 days, p=1.0) or 30-day readmission rate (9.4% vs 7.1%, p=0.66). There was no difference in patient-reported pain between the pre- and post-implementation cohorts on the day of discharge (severity 4.93 vs 5.14, p=0.53) or in any patient-reported symptoms, interference measures, or composite scores by post-discharge day 7. The median recovery time for most symptoms was 7 days, except for pain (14 days), fatigue (18 days), and physical interference (21 days), with no differences between cohorts.ConclusionsAfter implementation of a tiered opioid prescribing algorithm, the quantity and dose of discharge opioids prescribed decreased with no change in post-operative refills and without negatively impacting patient-reported symptom burden or interference, which can be used to educate and reassure patients and providers.

scholarly journals 2484. Patient Reported Outcomes After Switching to a 2-Drug Regimen of Dolutegravir + Rilpivirine: Week 148 Results from the Sword-1 and Sword-2 Studies

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S861-S861
Author(s):  
Alan Oglesby ◽  
Kostas Angelis ◽  
Yogesh Punekar ◽  
Vasiliki Chounta ◽  
Antonio Antela ◽  
...  
Keyword(s):  
Health Status ◽  
Treatment Satisfaction ◽  
Patient Reported Outcomes ◽  
Symptom Burden ◽  
Drug Regimen ◽  
Virologic Suppression ◽  
Symptom Bother ◽  
Alternative Treatment Option ◽  
Maximum Utility ◽  
Patient Reported

Abstract Background The SWORD-1 and SWORD-2 studies previously demonstrated that high rates of virologic suppression were maintained for 148 weeks after switching virologically suppressed HIV-1 infected adults from their current 3- or 4-drug antiretroviral regimen (CAR) to the 2-drug regimen (2DR) of dolutegravir + rilpivirine on Day 1 (Early Switch (ES) DTG+RPV group). This abstract reports the pooled SWORD-1/2 results of patient reported outcomes (PRO) measures through Week 148. Methods HIV Treatment Satisfaction Questionnaire (HIVTSQ) and Symptom Distress Module (SDM) were secondary PRO endpoints in the SWORD trials. For HIVTSQ, high scores represent greater treatment satisfaction (range 0 to 60). SDM was assessed using the Symptom Bother Score with low values indicating less symptom bother (range 0 to 80). The EQ-5D-5L measure of general health status was assessed as an exploratory endpoint with maximum utility score of 1 to indicate perfect health. Change from Baseline in these endpoints was calculated for the ES subjects (over 148 weeks). Subjects randomized to CAR switched to DTG+RPV at Week 52 (Late Switch (LS) DTG+RPV group) and change from LS Baseline (i.e., last pre-switch assessment) was calculated (over 96 weeks). Results Low Symptom Bother (9.6 and 10.3) and high TSQ scores (54.4 and 54.3) were reported pre-switch in the ES and LS groups, respectively. ES subjects reported modest improvements from Baseline in both symptom burden and overall treatment satisfaction in all visits through Week 148 (Figures 1 and 2). Among the LS group, there was little change in symptom burden but similar improvement in treatment satisfaction. Pre-switch health status was high in ES and LS groups (EQ-5D mean utility: 0.96 and 0.94, respectively) and remained stable in both groups at all time points. Conclusion High treatment satisfaction and low symptom burden that were observed in patients under CAR were maintained long term after switching to DTG+RPV. These results corroborate DTG+RPV as a well-tolerated 2DR alternative treatment option in patients currently suppressed on other 3/4-drug regimens without previous virologic failure. Disclosures All authors: No reported disclosures.

Measuring and improving symptom burden in radical cystectomy patients undergoing traditional care compared to enhanced recovery.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 340-340
Author(s):  
Janet Baack Kukreja ◽  
Courtney M Chang ◽  
Ting Yu Chen ◽  
Qiuling Shi ◽  
Xin Shelley Wang ◽  
...  
Keyword(s):  
Radical Cystectomy ◽  
Patient Reported Outcomes ◽  
Enhanced Recovery ◽  
Multivariable Analysis ◽  
Symptom Burden ◽  
Abdominal Discomfort ◽  
Dry Mouth ◽  
Disturbed Sleep ◽  
Patient Reported ◽  
Traditional Care

340 Background: Bladder cancer is a disease of the elderly associated with high morbidity in those undergoing radical cystectomy (RC). The Optimized Surgical Journey (OSJ) uses enhanced recovery after surgery (ERAS) principles for RC patients to improve postoperative pain and shorten hospital stay. There have been few patient reported outcomes studied in OSJ and ERAS patients. The MD Anderson Symptom Inventory (MDASI) is patient reported outcome measures used for clinical and research purposes related to cancer and its treatment. Our objective was to determine if patient reported outcomes using MDASIs are different in patients following the OSJ compared to a traditional care pathway. Methods: From July 2013 to November 2015, MDASIs were collected from 160 RC patients preoperatively and on postoperative days (POD) 1 through 3. The MDASI consists of 19 core symptom burden related questions and 6 questions analyzing how symptoms have interfered with the patient’s life. Using a 0-10 scale, patient’s rate their symptoms. T-test, Man-Whitney where appropriate and logistic regression were used for multivariable cross sectional analysis. Results: The most bothersome symptoms were abdominal discomfort, disturbed sleep, dry mouth, fatigue, and drowsiness. Nausea, vomiting, bowel pattern, bowel control and appetite were all found to be insignificant. Abdominal discomfort was reported significantly less in OSJ patients on PODs 1 and 2 (p = 0.032 and 0.001, respectively). In multivariable analysis OSJ status was predictive of less abdominal pain (p < 0.001). Dry mouth was also significantly burdensome on PODs 1 and 2 (p = 0.022 and < 0.001, respectively) in non-OSJ patients. Less dry mouth was also predicted by OSJ status in multivariable analysis (p = 0.014). Disturbed sleep, fatigue, and drowsiness were significantly less in patients on the OSJ POD 2. Mood was better in OSJ patients PODs 2 and 3 (p = 0.016). Conclusions: The OSJ can significantly reduce the burden of symptoms in RC patients immediately postoperatively. MDASIs maybe a helpful tool to measure symptom burden. This information can be used in the future to create additional interventions for improvement in RC patient recovery experiences.

Utilizing patient reported outcomes for patients recieving oral chemotherapy.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 190-190 ◽  
Author(s):  
Emily R. Mackler ◽  
Kathleen W. Beekman ◽  
Laura Bushey ◽  
Anne Gentz ◽  
Kathleen Davis ◽  
...  
Keyword(s):  
Side Effects ◽  
Side Effect ◽  
Patient Reported Outcomes ◽  
Symptom Burden ◽  
Symptom Assessment ◽  
Oral Chemotherapy ◽  
Severe Side Effect ◽  
Management Support ◽  
Patient Reported ◽  
Edmonton Symptom Assessment Scale

190 Background: Management of oral chemotherapy presents many challenges to oncology practitioners. The purpose of this study is to describe how incorporation of patient reported outcomes (PRO) for patients receiving oral chemotherapy can identify those patients who are experiencing moderate to severe symptom burden and nonadherence. Methods: As part of a statewide quality collaborative, we wished to improve our monitoring of patients receiving oral chemotherapy. The quality collaborative created a PRO assessment that includes a revised Edmonton Symptom Assessment Scale (ESAS), a single-item adherence question, reasons for nonadherence, the patient’s most bothersome symptom and questions related to patient confidence. Our medical assistants provide the assessment to the patient before each appointment. Results: Patients completing the PRO during the first 3 months (7/7/16 – 9/27/16) were evaluated. We had 32 assessments completed by 23 patients. The oral chemotherapy prescribed were capecitabine (48%), erlotinib (13%), temozolomide (13%), and not recorded (26%). Of the 29 completed ESAS assessments, 72% included at least 1 moderate side effect, and 48% included at least 1 severe side effect. 29% of patients reported low-moderate confidence to self-manage their symptoms. Less than excellent adherence (<80% adherence) was reported in 30% of patients with the most commonly reported reason being related to side effects or concerns about side effects. Conclusions: Use of PROs in our oral chemotherapy population identified a large proportion of patients experiencing moderate to severe side effects. Further assessment of how this compares to what patients report to their oncologist during their visits will be reviewed. In addition, we found that approximately 30% of our patients are nonadherent to their oral chemotherapy. This is consistent with recent publications. We plan to continue assessing patient outcomes and utilizing the data we collect to improve patient self-management support.

Are real-world patient-reported outcomes associated with survival in patients with advanced pancreatic cancer?

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 205-205
Author(s):  
Wei Fang Dai ◽  
Jaclyn Marie Beca ◽  
Helen Guo ◽  
Lucy Qiao ◽  
Wanrudee Isaranuwatchai ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Symptom Score ◽  
Patient Reported Outcomes ◽  
Cox Model ◽  
Advanced Pancreatic Cancer ◽  
Symptom Burden ◽  
Physical Symptoms ◽  
Funding Program ◽  
Patient Reported ◽  
Edmonton Symptom Assessment Scale

205 Background: Advanced pancreatic cancer (APC) patients often have a substantial symptom burden. In Ontario, patients visiting cancer clinics routinely complete the Edmonton Symptom Assessment Scale (ESAS), which screens for 9 symptoms (scale: 0-10). Using ESAS, we explored the association between baseline patient-reported outcomes and overall survival (OS). Methods: APC Patients with ESAS records prior to receiving publicly-funded drugs from November 2008 to March 2016 were identified from Cancer Care Ontario’s New Drug Funding Program and Symptom Management databases. We examined 3 baseline composite ESAS scores: Total Symptom Distress Score (TSDS: all 9 symptoms), Physical Symptom Score (PHS: 6/9 symptoms), and Psychological Symptom Score (PSS: 2/9 symptoms); Composite scores greater than a threshold (defined as number of symptoms in composite score multiplied by clinically relevant score (≥4)) were categorized as High Symptom Burden (TSDS ≥ 36, PHS ≥ 24, PSS ≥ 8). The primary endpoint, OS, was assessed using Kaplan-Meier. Multivariable Cox models were used to adjust for age, gender, income, prior therapies (surgery, adjuvant gemcitabine, radiation), and Charlson's comorbidity. Analysis was repeated in a sub-cohort with identifiable ECOG status and stage. Results: We identified 2,199 APC patients (mean age 64 years, 55% male) with ESAS records prior to receiving gemcitabine (54%), FOLFIRINOX (40%) or gemcitabine/nab-paclitaxel (6%). Crude median survival was 4.5 and 7.3 months for patients with high and low TSDS burden, respectively (HR = 1.50, 95% CI: 1.36, 1.66). After adjustment with multivariable Cox model, high TSDS burden was associated with lower OS (HR = 1.47, 95% CI: 1.33, 1.63). Similar trends were observed for PHS and PSS. When adjusting for both PHS and PSS in a Cox model, only the effect of PHS remained significant. In the sub-cohort (n = 393), high TSDS burden (HR = 1.34, 95% CI: 1.04, 1.73) was associated with lower OS, after adjusting for ECOG and stage. Conclusions: Among APC patients, a higher burden of patient-reported symptoms, via ESAS, at baseline was associated with reduced OS. The effect was prominent for physical symptoms, even after adjusting for treatment, stage and ECOG.

scholarly journals Patient Reported Outcomes in Penile Cancer

2021 ◽  
Author(s):  
Irini Youssef ◽  
Aasha Hoogland ◽  
Jad Chahoud ◽  
Philippe Spiess ◽  
Heather Jim ◽  
...  
Keyword(s):  
Symptom Score ◽  
Penile Cancer ◽  
Patient Reported Outcomes ◽  
Recurrent Disease ◽  
Symptom Burden ◽  
Symptom Assessment ◽  
Patient Reports ◽  
Patient Reported ◽  
Edmonton Symptom Assessment Scale ◽  
Partial Penectomy

Abstract Objective: Patient reports of their symptom burden (i.e., patient-reported outcomes or PROs) have been shown to direct clinicians’ ability to personalize care and improve outcomes. A disciplined assessment of PRO in the population of patients with penile cancer (PeCa) has not previously been undertaken. Our center has both a significant cadre of patients with PeCa and a significant experience with a well-established PRO: the Edmonton Symptom Assessment Scale (ESAS).Methods: After IRB approval, we screened ESAS surveys of 14,781 patients completed between 2/2017 and 2/2021. Of these, those with PeCa were divided into three cohorts: (A) Those after any partial penectomy procedure without lymph node dissection (LND); (B) Those after partial penectomy procedure with LND; and (C) Those after total penectomy and LND. Patients with recurrent disease were analyzed separately. ESAS scores were collated and compared both by individual symptom and cumulatively.Results: 22 PeCa patients completed 122 ESAS surveys in this time and are included in this analysis: a median of 4 ESAS surveys (mean=5, range=1-19) were completed by each patient. The symptom with the highest median ESAS score was Tiredness (3.00). Patients with recurrent disease had the highest cumulative symptom score (median score = 30). Patients after total penectomy with LND had a higher cumulative symptom score (14.4) than those with partial penectomy and LND (7.9).Conclusions: PROs provide an insight into the morbidity of therapies for PeCa, and the most symptoms are reported by patients with recurrent disease.

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