Assessing Symptom Burden and Depression in Subjects With Chronic Respiratory Insufficiency

2021 ◽  
pp. 082585972110495
Author(s):  
Heidi A. Rantala ◽  
Sirpa Leivo-Korpela ◽  
Lauri Lehtimäki ◽  
Juho T. Lehto
Keyword(s):  
Respiratory Insufficiency ◽  
Advanced Disease ◽  
Depression Scale ◽  
Symptom Burden ◽  
Depression Score ◽  
Assessment System ◽  
Dry Mouth ◽  
Depression Symptom ◽  
Shortness Of Breath ◽  
Chronic Respiratory Insufficiency

Objectives: Patients with chronic respiratory insufficiency suffer from advanced disease, but their overall symptom burden is poorly described. We evaluated the symptoms and screening of depression in subjects with chronic respiratory insufficiency by using the Edmonton symptom assessment system (ESAS). Methods: In this retrospective study, 226 subjects with chronic respiratory insufficiency answered the ESAS questionnaire measuring symptoms on a scale from 0 (no symptoms) to 10 (worst possible symptom), and the depression scale (DEPS) questionnaire, in which the cut-off point for depressive symptoms is 9. Results: The most severe symptoms measured with ESAS (median [interquartile range]) were shortness of breath 4.0 (1.0-7.0), dry mouth 3.0 (1.0-7.0), tiredness 3.0 (1.0-6.0), and pain on movement 3.0 (0.0-6.0). Subjects with a chronic obstructive pulmonary disease as a cause for chronic respiratory insufficiency had significantly higher scores for shortness of breath, dry mouth, and loss of appetite compared to others. Subjects with DEPS ≥9 reported significantly higher symptom scores in all ESAS categories than subjects with DEPS <9. The area under the receiver operating characteristic curve for ESAS depression score predicting DEPS ≥9 was 0.840 ( P < .001). If the ESAS depression score was 0, there was an 89% probability of the DEPS being <9, and if the ESAS depression score was ≥4, there was an 89% probability of the DEPS being ≥9. The relation between ESAS depression score and DEPS was independent of subjects’ characteristics and other ESAS items. Conclusions: Subjects with chronic respiratory insufficiency suffer from a high symptom burden due to their advanced disease. The severity of symptoms increases with depression and 4 or more points in the depression question of ESAS should lead to a closer diagnostic evaluation of depression. Symptom-centered palliative care including psychosocial aspects should be early integrated into the treatment of respiratory insufficiency.

scholarly journals Dyspnea is associated with overall symptom burden in patients with chronic respiratory insufficiency

2020 ◽  
Author(s):  
Heidi Anniina Rantala ◽  
Sirpa Leivo-Korpela ◽  
Juho T. Lehto ◽  
Lauri Lehtimäki
Keyword(s):  
Respiratory Insufficiency ◽  
Depression Scale ◽  
Symptom Burden ◽  
Symptom Assessment ◽  
Assessment System ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Edmonton Symptom Assessment System ◽  
Symptom Screening ◽  
Chronic Respiratory Insufficiency

Abstract Objective Patients with chronic respiratory insufficiency suffer from many symptoms together with dyspnea. We evaluated the association of dyspnea with other symptoms in patients with chronic respiratory insufficiency due to chronic obstructive pulmonary disease or interstitial lung disease. Results This retrospective study included 101 patients. Dyspnea was assessed with modified Medical Research Council dyspnea questionnaire (mMRC) and other symptoms with Edmonton Symptom Assessment System (ESAS) and Depression Scale (DEPS). Patients with mMRC 4 (most severe dyspnea) compared to those with mMRC 0–3 reported higher median (IQR) symptom scores on ESAS in e.g. dry mouth (7.0 (4.0–8.0) vs. 3.0 (1.0–6.0), P < 0.001), tiredness (6.0 (3.0–7.0) vs. 3.0 (1.0–5.0), P < 0.001) and anxiety (3.0 (0.0-5.5) vs. 1.0 (0.0–3.0), P = 0.007). Patients with mMRC 4 were more likely to reach the DEPS threshold for depression compared to those with mMRC 0–3 (42.1% vs. 20.8%, P = 0.028). In conclusion, patients with chronic respiratory insufficiency need comprehensive symptom screening with relevant treatment, as they suffer from many severe symptoms worsening with increased dyspnea.

scholarly journals Dyspnea on Exercise Is Associated with Overall Symptom Burden in Patients with Chronic Respiratory Insufficiency

2021 ◽  
Vol 2 (1) ◽  
pp. 48-53
Author(s):  
Heidi A. Rantala ◽  
Sirpa Leivo-Korpela ◽  
Juho T. Lehto ◽  
Lauri Lehtimäki
Keyword(s):  
Respiratory Insufficiency ◽  
Symptom Burden ◽  
Chronic Respiratory Insufficiency

Assessing symptom burden and depression in patients with chronic respiratory insufficiency.

2020 ◽  
Author(s):  
Heidi Rantala ◽  
Sirpa Leivo-Korpela ◽  
Anni Hanhimäki ◽  
Lauri Lehtimäki ◽  
Juho T Lehto
Keyword(s):  
Respiratory Insufficiency ◽  
Symptom Burden ◽  
Chronic Respiratory Insufficiency

scholarly journals Wish to die and hasten death in palliative care: a cross-sectional study factor analysis

2021 ◽  
pp. bmjspcare-2021-003080
Author(s):  
Alazne Belar ◽  
Marina Martinez ◽  
Carlos Centeno ◽  
Jesús López-Fidalgo ◽  
Yolanda Santesteban ◽  
...  
Keyword(s):  
Predictive Factors ◽  
Protective Factor ◽  
Depression Scale ◽  
Symptom Burden ◽  
Cross Sectional Study ◽  
Assessment System ◽  
Sectional Study ◽  
Advanced Illness ◽  
Cross Sectional ◽  
Wish To Die

ObjectivesThe wish to die (WTD) is a complex experience sometimes accompanied by intention to hasten death. The aim of this study is to identify the predictive factors for WTD and hastening death intention (HDI) in Spanish patients with advanced illness.MethodsThis is a subanalysis of a larger cross-sectional study conducted on patients experiencing advanced illness (N=201). Sociodemographic data and data related to symptom burden (Edmonton Symptom Assessment System-Revised), depressive and anxious symptoms (Hospital Anxiety and Depression Scale), demoralisation (Spanish version of the Demoralisation Scale), perceived loss of dignity (Patient Dignity Inventory) and WTD (Assessing Frequency and Extent of Desire to Die) were collected. The analysis used univariate and multivariate logistic regression.ResultsThe prevalence of WTD in the sample was 18%, with 8 out of 36 patients reporting HDI. The independent factors predictive of WTD were (1) knowledge of approximate prognosis (OR=4.78; 95% CI 1.20 to 10.8; p=0.001); (2) symptom burden (OR=1.05; 95% CI 1.00 to 1.09; p=0.038); and (3) the Demoralisation Scale subsection ‘lack of meaning and purpose in life’ (OR=1.61; 95% CI 1.30 to 1.99; p=0.000). An independent predictive factor for HDI was the Demoralisation Scale subsection ‘patients’ distress and coping abilities’ (OR=1.47; 95% CI 1.04 to 2.08; p=0.028), while having religious beliefs was a protective factor (OR=0.13; 95% CI0.17 to 0.97; p=0.047).ConclusionsDemoralisation was found to be the only common triggering factor for WTD and HDI, although experiences share certain features. Identification of the predictive factors for WTD and HDI may contribute to their prevention and management.

Comparison of Symptom Burden in Acute Myeloid Leukemia (AML) and Myelodysplastic Syndrome (MDS)

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2652-2652 ◽  
Author(s):  
Loretta A. Williams ◽  
Hycienth Ahaneku ◽  
Jorge E. Cortes ◽  
Guillermo Garcia Manero ◽  
Hagop M. Kantarjian ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Myelodysplastic Syndrome ◽  
Myeloid Leukemia ◽  
Symptom Burden ◽  
Dry Mouth ◽  
Shortness Of Breath ◽  
General Activity ◽  
Specific Symptom ◽  
Core Symptom ◽  
Acute Myeloid

Abstract Objective: Patient report of symptom burden from acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) is scarce. Symptom burden is the combined impact of symptoms from disease and treatment on daily functioning. We are developing a measure of symptom burden in AML and MDS. The purpose of this interim analysis is to compare the symptom burden of patients with AML and MDS. Methods: Patients with AML or MDS rated the 13 core symptom items, 6 proposed AML/MDS-specific symptom items, and 6 interference items of the MD Anderson Symptom Inventory on a 0-10 scale (0 = not present or no interference; 10 = as bad as can be imagined or complete interference). Patient clinical and demographic information was collected from medical records. The symptom burden of AML/MDS was determined and compared using descriptive statistics and t-tests. Results: Mean ages of the 45 AML patients and 48 MDS patients were 62.4 (standard deviation [SD] = 11.3) and 68.5 years (SD = 9.2; p = 0.005), respectively; 61% and 60% (p = not significant), respectively, were male; 76% and 92% (p = 0.043), respectively, were white. The composite mean severity score of the core symptom items was 2.75 (SD = 1.58) and 1.84 (SD = 1.52; p = 0.006), the composite mean of the AML/MDS specific items was 2.51 (SD = 1.87) and 1.49 (1.60; p = 0.005), and the composite mean score of the interference items was 3.96 (SD = 2.72) and 2.81 (SD = 2.69; p = 0.042) for the AML and MDS patients, respectively. The means, ranks, significance of difference in ratings, and prevalence of the individual symptom and interference items for the AML and MDS patients are in Table 1. Cronbach α for all symptom items was 0.94 and for all interference items was 0.92. Conclusions: Patients with AML and MDS experience similar symptoms. However, patients with AML report significantly more severe pain, fatigue, nausea, lack of appetite, dry mouth, vomiting, fever, and headache than patients with MDS. Only prevalence of shortness of breath and diarrhea was higher in MDS patients, but there was no difference in reported mean severity of these symptoms. Except for general activity, rating of symptom interference with daily activities is similar for the two groups. Lack of recognition of symptoms experienced by patients with AML and MDS can lead to inadequate management of symptoms, interfere with patients' ability to function and enjoy life, and impact the tolerability of and adherence to treatment regimens. Validation of this measure of symptom burden for patients with AML and MDS to allow more accurate and consistent monitoring of symptoms by clinicians and in clinical research is ongoing. Table 1. Individual MDASI Item Means and Significance for AML and MDS Patients Core Symptom Items N Mean SD p-value Rank Prevalence (%) Pain MDS 48 2.00 2.760 0.009* 9 58 AML 45 3.69 3.309 3 69 Fatigue MDS 47 3.45 2.947 0.037* 1 79 AML 45 4.69 2.653 1 91 Nausea MDS 48 .50 1.368 <0.001* 17 23 AML 45 2.67 3.233 9 58 Disturbed Sleep MDS 48 2.38 3.050 0.124 4 56 AML 45 3.38 3.172 7 71 Distress MDS 48 2.19 2.498 0.476 7 63 AML 45 2.56 2.455 10 71 Shortness of Breath MDS 48 2.15 2.518 0.543 8 65 AML 45 1.84 2.215 17 53 Problems Remembering MDS 48 1.94 2.025 0.663 10 71 AML 45 2.13 2.292 14 71 Lack of Appetite MDS 48 1.33 2.035 <0.001* 13 48 AML 45 3.73 3.460 2 76 Drowsiness MDS 48 2.85 3.032 0.187 2 71 AML 45 3.69 3.021 3 78 Dry Mouth MDS 48 2.31 2.746 0.045* 6 69 AML 44 3.59 3.223 5 73 Sadness MDS 48 1.83 2.127 0.394 11 60 AML 45 2.22 2.255 11 73 Vomiting MDS 48 0.00 0.000 0.009* 19 0 AML 45 .73 1.912 19 22 Numbness or Tingling MDS 48 1.08 2.071 .712 15 33 AML 45 .93 1.814 18 33 AML/MDS-Specific Symptom Items Malaise MDS 48 2.46 2.843 0.133 3 65 AML 46 3.35 2.838 8 78 Fever MDS 48 .50 1.544 0.006* 18 19 AML 46 1.91 3.002 16 41 Headache MDS 48 .81 1.483 0.011* 16 35 AML 46 2.22 3.339 11 44 Diarrhea MDS 48 1.56 2.567 0.512 12 48 AML 46 1.96 3.211 15 41 Muscle Weakness MDS 48 2.35 2.899 0.063 5 60 AML 46 3.43 2.664 6 83 Rash or Skin Problems MDS 48 1.23 2.469 0.065 14 38 AML 46 2.22 2.666 11 59 Interference Items General Activity MDS 46 3.20 3.449 0.031* 3 65 AML 46 4.83 3.696 2 80 Mood MDS 48 2.38 2.687 0.066 5 65 AML 44 3.48 2.984 5 80 Work MDS 48 3.54 3.638 0.086 1 67 AML 46 4.87 3.781 1 78 Relations with Others MDS 48 1.69 2.683 0.154 6 48 AML 46 2.54 3.082 6 52 Walking MDS 48 2.88 3.112 0.275 4 71 AML 46 3.57 2.971 4 78 Enjoyment of Life MDS 48 3.21 3.261 0.055 2 73 AML 46 4.54 3.397 3 80 * Significant at p < 0.05. Disclosures No relevant conflicts of interest to declare.

Development of patient reported outcomes-based machine learning algorithm for the six-month mortality prediction in patients with advanced cancer.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 273-273
Author(s):  
Ishwaria Mohan Subbiah ◽  
Cai Xu ◽  
Sheng-Chieh Lu ◽  
Ali Haider ◽  
Ahsan Azhar ◽  
...  
Keyword(s):  
Machine Learning ◽  
Advanced Cancer ◽  
Patient Reported Outcomes ◽  
Symptom Burden ◽  
Mortality Prediction ◽  
Assessment System ◽  
Shortness Of Breath ◽  
Extreme Gradient Boosting ◽  
Patient Reported ◽  
Systemic Therapies

273 Background: To date, studies of machine learning (ML) algorithms within oncology for mortality prediction have focused on structured electronic health record (EHR) data. Given the complex symptom burden of patients with advanced cancers, ML models may be better suited to identify patterns and interactions between symptom burden and outcomes compared to traditional statistical methods. To that end, in this study, we leverage the patient reported outcomes (PRO) data together with clinical EHR-based variables to assess the performance of ML algorithms to predict mortality in patients with advanced cancers. Methods: We randomly selected 689 patients with advanced cancer who had their first Palliative Care encounter between January 2012 and December 2017. 59 patients were lost to follow-up and were excluded from this analysis. The remaining cohort of 630 patients was split 4:1 randomly into a training and validation set to develop and test a supervised ML algorithm (Extreme Gradient Boosting [XGB] tree) to predict the 6-month mortality. Candidate variables for algorithm development included gender, age, ECOG performance status (PS), number of prior systemic therapies, and scores on the Edmonton Symptom Assessment System (ESAS)-FS, a 12-item PRO measure of physical and psychosocial symptom burden include the composite Physical Symptom Score (PHS), a sum of the physical ESAS symptoms (pain, fatigue, nausea, drowsiness, shortness of breath, appetite, wellbeing, sleep). Results: Overall, 630 patients were included in this 6-month mortality prediction; mean age 59 years, 354 (56%) female; 276 (44%) male. Variables with the most significant impact on the XGB tree mortality prediction were the ESAS symptoms of shortness of breath (1-AUC, 0.295), appetite, ESAS PHS, financial distress, age, and appetite as well as ECOG PS and number of prior systemic therapies. The XGB tree algorithm demonstrated the best overall prediction performance of 6-month mortality in the independent testing set, AUC 0.716 (95% CI 0.63 - 0.81), sensitivity 0.75 (95% CI 0.66 - 0.87), and a positive predictive value 0.67 (95% CI 0.57 - 0.79). Conclusions: Our ML model leveraged PRO-based assessment of symptom burden to correctly identify the majority of patients who died within 6 months. These models are uniquely positioned to not only automatically identify patients at high risk for short-term mortality but also the specific symptoms of concern for clinical intervention. Such models can be applied to available clinical and PRO data to facilitate clinical decision-making. Futures studies on improving model performance with the inclusion of interventions to modify symptom burden are in design.

scholarly journals Interaction between Subjective Memory Decline and Depression Symptom Intensity in Older People. Results of the Second Wave of Cognition of Older People, Education, Recreational Activities, Nutrition, Comorbidities, and Functional Capacity Studies (COPERNICUS)

2021 ◽  
Vol 10 (7) ◽  
pp. 1334
Author(s):  
Sławomir Kujawski ◽  
Agnieszka Kujawska ◽  
Radosław Perkowski ◽  
Joanna Androsiuk-Perkowska ◽  
Weronika Hajec ◽  
...  
Keyword(s):  
Older People ◽  
Memory Impairment ◽  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Depression Symptoms ◽  
Depression Symptom ◽  
Subjective Memory ◽  
Delayed Recall ◽  
Mediating Role ◽  
Symptom Intensity

Background: Prevalence of subjective memory impairment (SMC), with or without objective memory impairment, and the mediating role of depression symptom intensity was examined in older people. Methods: n = 205 subjects (60 years old and older) were examined and followed up at two years. Cognitive function was examined using the Montreal Cognitive Assessment (MoCA) Delayed Recall (DR) subtest. Geriatric Depression Scale (GDS) was used as a screening tool for depression. Statistical analysis was performed using linear mixed models. Results: A total of 144 subjects (70.24%) had SMC. MoCA Delayed Recall scores were not significantly changed in relation to time and SMC. Dynamics of SMC significantly influenced changes in GDS score (p = 0.008). Conclusions: SMC and objective memory impairment do not fully overlap each other. Subjects without SMC for longer than two years noted less intensity of depression symptoms in comparison to subgroup with SMC. However, occurrence of SMC in subjects who were previously free of SMC, was not related to increase in depression symptom intensity.

scholarly journals Longitudinal study of symptom burden in outpatients with advanced cancers based on electronic Patient-Reported Outcome (ePRO) platform: a single institution, prospective study protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e038223
Author(s):  
Lili Tang ◽  
Ying Pang ◽  
Yi He ◽  
Qiuling Shi ◽  
Xinkun Han ◽  
...  
Keyword(s):  
Study Protocol ◽  
Symptom Management ◽  
Depression Scale ◽  
Symptom Burden ◽  
Patient Reported Outcome ◽  
Critical Parameters ◽  
Advanced Lung Cancer ◽  
Optimal Time ◽  
Patient Reported

IntroductionAn electronic Patient-Reported Outcome (ePRO) platform is needed for implementing evidence-based symptom management in outpatients with advanced cancer. We describe the overall protocol and the methodology for measuring symptom burden, to provide critical parameters needed to implement symptom management on the ePRO platform.Methods and analysisThe study focusses on patients with advanced lung cancer, stomach cancer, oesophagus cancer, liver cancer, colorectal cancer or breast cancer. The primary outcome is the change of symptom burden. MD Anderson Symptom Inventory, and other PRO instruments (Insomnia Severity Index, Hospital Anxiety and Depression Scale, 9-item Patient Health Questionnaire and EuroQol-5 dimensions-5 levels version) were used. The secondary outcomes include feasibility of using ePRO, symptom-related quality of life, reasons for no improvement of symptoms, defining frequency of PRO assessments and cut-points, items for screening and management of comorbidity and satisfaction with ePRO platform in patients and health providers. After initial outpatient visit for baseline assessment, ePRO system will automatically send follow-up notification seven times over 4 weeks to patients. The characteristics and changing trajectory of symptoms of patients will be described. Parameters for using PROs, such as optimal time points for follow-up and cut-off point for alert will be determined. The feasibility of ePRO platform to track the changes of target symptoms in outpatients will be evaluated.Ethics and disseminationThe study protocol and related documents were approved by the Institutional Research Board (IRB) of Peking University Cancer Hospital on 13 February 2019 (2019YJZ07). The results of this study will be disseminated through academic workshops, peer-reviewed publications and conferences.Trial registration numberChiCTR1900023560.

The Role of CO-RADS Scoring System in the Diagnosis of COVID-19 Infection and its Correlation with Clinical Signs

2021 ◽  
Vol 17 ◽  
Author(s):  
Şenol Çomoğlu ◽  
Sinan Öztürk ◽  
Ahmet Topçu ◽  
Fatma Kulalı ◽  
Aydın Kant ◽  
...  
Keyword(s):  
Scoring System ◽  
Clinical Signs ◽  
Assessment System ◽  
Symptom Duration ◽  
Shortness Of Breath ◽  
Laboratory Findings ◽  
Ct Findings ◽  
Chronic Pulmonary Diseases ◽  
Ct Evaluation ◽  
The Difference

Background: Computed tomography (CT) evaluation systematics has become necessary to eliminate the difference of opinion among radiologists in evaluating COVID-19 CT findings. Introduction: The objectives of this study were to evaluate the efficiency of CO-RADS scoring system in our patients with COVID-19 as well as to examine its correlation with clinical and laboratory findings. Method: The CO-RADS category of all patients included in the study was determined by a radiologist who did not know the rtRT-PCR test result of the patients, according to the Covid-19 reporting and data system of Mathias Prokop et al. Results: A total of 1338 patients were included. CT findings were positive in 66.3%, with a mean CO-RADS score of 3,4 ± 1,7. 444 (33.1%) of the patients were in the CO-RADS 1-2, 894 (66.9%) were in the CO-RADS 3-5 group. There were positive correlations between CO-RADS score and age, CMI, hypertension, diabetes mellitus, chronic pulmonary diseases presence of symptoms, symptom duration, presence of cough, shortness of breath, malaise, CRP, and LDH, while CO-RADS score was negatively correlated with lymphocyte count. The results of the ROC analysis suggested that those with age ≥40 years, symptom duration >2 days, CMI score >1 and/or comorbid conditions were more likely to have a CO-RADS score of 3-5. Conclusion: The CO-RADS classification system is a CT findings assessment system that can be used to diagnose COVID-19 in patients with symptoms of cough, shortness of breath, myalgia and fatigue for more than two days.

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