Characteristics and Symptom Burden of Patients Accessing Acupuncture Services at a Cancer Hospital

Background: Patients with cancer are often impacted by a significant symptom burden. Cancer hospitals increasingly recognize the value of complementary and integrative therapies to support the management of cancer related symptoms. The aim of this study is to provide a better understanding of the demographic characteristics and symptoms experienced by cancer patients who access acupuncture services in a tertiary hospital in Australia. Methods: A retrospective audit was conducted of patients that presented to the acupuncture service at Chris O’Brien Lifehouse between July 2017 and December 2018. Edmonton Symptom Assessment Scale (ESAS) and Measure Yourself Concerns and Wellbeing (MYCaW) outcome measures were used. The quantitative data was analyzed using descriptive statistics and Principal Component Analysis. Results: A total of 127 inpatients and outpatients (mean age 55, range 19-85) were included with 441 individual surveys completed (264 ESAS, 177 MYCaW). Patients were predominantly female (76.8%) and breast cancer was the most prevalent primary diagnosis (48%). The most prevalent symptoms in the ESAS were sleep problems (88.6%), fatigue (88.3%), lack of wellbeing (88.1%), and memory difficulty (82.6%). Similarly, symptoms with the highest mean scores were numbness, fatigue, sleep problems and hot flushes, whilst neuropathy, and hot flashes were scored as the most severe (score ≥7) by patients. Cluster analysis yielded 3 symptom clusters, 2 included “physical symptoms” (pain, sleep problems, fatigue and numbness/neuropathy), and (nausea, appetite, general well-being), whilst the third included “psychological” symptoms (anxiety, depression, spiritual pain, financial distress). The most frequent concerns expressed by patients (MyCaW) seeking acupuncture were side effects of chemotherapy (24.6%) and pain (20.8%). Conclusion: This audit highlights the most prevalent symptoms, the symptoms with the greatest burden and the types of patients that receive acupuncture services at an Australian tertiary hospital setting. The findings of this audit provide direction for future acupuncture practices and research in hospital settings.

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Feasibility and acceptability of hypnosis-derived communication administered by trained nurses to improve patient well-being during outpatient chemotherapy: a pilot-controlled trial

Supportive Care in Cancer ◽

10.1007/s00520-021-06481-6 ◽

2021 ◽

Author(s):

Caroline Arbour ◽

Marjorie Tremblay ◽

David Ogez ◽

Chloé Martineau-Lessard ◽

Gilles Lavigne ◽

...

Keyword(s):

Usual Care ◽

Emotional Support ◽

Symptom Management ◽

Controlled Trial ◽

Well Being ◽

Physical Symptoms ◽

Intervention Site ◽

Outpatient Chemotherapy ◽

Edmonton Symptom Assessment Scale ◽

Contrast Perception

Abstract Purpose This pilot-controlled trial aimed to examine the feasibility and acceptability of hypnosis-derived communication (HC) administered by trained nurses during outpatient chemotherapy to optimize symptom management and emotional support — two important aspects of patient well-being in oncology. Methods The trial was conducted in two outpatient oncology units: (1) intervention site (usual care with HC), and (2) control site (usual care). Nurses at the intervention site were invited to take part in an 8-h training in HC. Participants’ self-ratings of symptoms and emotional support were gathered at predetermined time points during three consecutive outpatient visits using the Edmonton Symptom Assessment Scale and the Emotional Support Scale. Results Forty-nine patients (24 in the intervention group, 25 in the control group) with different cancer types/stages were recruited over a period of 3 weeks and completed the study. All nurses (N = 10) at the intervention site volunteered to complete the training and were able to include HC into their chemotherapy protocols (about ± 5 min/intervention). Compared to usual care, patients exposed to HC showed a significant reduction in physical symptoms during chemotherapy. In contrast, perception of emotional support did not show any significant effect of the intervention. Participants exposed to HC report that the intervention helped them relax and connect on a more personal level with the nurse during chemotherapy infusion. Conclusions Our results suggest that HC is feasible, acceptable, and beneficial for symptom management during outpatient chemotherapy. While future studies are needed, hypnosis techniques could facilitate meaningful contacts between cancer patients and clinicians in oncology. Trial registration Clinical Trial Identifier: NCT04173195, first posted on November 19, 2019

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Effects of animal-assisted visits on quality of life during multi-modal radiation therapy: Chemotherapy regimens.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e20607 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e20607-e20607

Author(s):

Stewart Barry Fleishman ◽

Victoria Rosenwald ◽

Peter Homel

Keyword(s):

Radiation Therapy ◽

Psychological Symptoms ◽

Symptom Burden ◽

Well Being ◽

Physical Symptoms ◽

External Beam Radiation ◽

Beam Radiation ◽

Positive Attitudes ◽

Intent To Treat ◽

High Level

e20607 Background: Animal-assisted visits (AAV) are known to affect blood pressure, mood and anxiety, yet their effects in cancer remained unexamined. Methods: 42 subjects signed IRB-approved informed consent to have AAVs daily during multi-modal chemotherapy and radiation therapy for head & neck cancer. 37 subjects completed at least baseline assessment visits for an intent to treat analysis. Assessments included FACT-Head and Neck scale; Satisfaction with AAV Intervention (SAAVI) assessing bi-weekly motivation to attend appointments, tolerance of waits, ability to withstand treatment, lingering effect of AAV after treatment and perception of social support. Subject characteristics: 25 (68%) male, mean age 57 years (57.22 ±8.44); (57%) white, 8 (22%) Hispanic, 6 (16%) black and 2 (5%) Asian. Cancer sites: oropharynx 23 (62%), hypopharynx 4 (11%), esophagus 3 (8%), laryngopharynx 2 (5%) and nasal cavity 2 (5%). Stage: stage II: 1 (3%), III: 6 (16%), IV: 30 (81%). All subjects received concomitant external beam radiation therapy with periodic cis-platin (23 pts, 57%), weekly carboplatin (7 pts; 16%) or cetuximab (5; 11%). Results: Comparing baseline, week 3 and week 7 assessments, FACT Physical Well-being (PWB; p<0.001) and Functional Well-Being (FWB; (p=0.003) showed significant declines; in contrast, Social Well-Being (SWB; p = 0.03) showed significant gains. Controlling for declines in PWB, increases in EWB were also significant (p = 0.004). Satisfaction was measured after the first and last AAV. Mean scores for satisfaction related to psychological symptoms, generally liking animals/pets, and positive attitudes towards pets at both times were significantly better than “Neutral” or “Unsure” (all p < 0.001), and did not change from first to last AAV. Mean scores for physical symptoms were not significantly different from “Neutral.” Conclusions: FACT analysis showed significant increase in EWB in the face of clinically evident and expected declines in PWB and FWB in spite of high symptom burden. The SAAVI assessment further supports the utility of the AAV intervention. Though self-selected for an affinity to pets and animals, subjects endorsed a high level of satisfaction with the intervention.

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

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.30_suppl.205 ◽

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.

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Sleep Disturbance in Cancer Patients Referred to an Ambulatory Integrative Oncology Consultation

10.21203/rs.3.rs-662550/v1 ◽

2021 ◽

Author(s):

Santhosshi Narayanan ◽

Akhila Reddy ◽

Gabriel Lopez ◽

Wenli Liu ◽

Sara Ali ◽

...

Keyword(s):

Sleep Disturbance ◽

Eligible Patient ◽

Hot Flashes ◽

Well Being ◽

Published Data ◽

Poor Sleep ◽

Integrative Oncology ◽

Factors Associated ◽

Patient Reported ◽

Edmonton Symptom Assessment Scale

Abstract Background Sleep disturbance (SD) is highly prevalent in oncology and negatively affects quality of life and mortality. Evidence supports the use of integrative oncology (IO) practices to treat SD, but there is limited published data on the characteristics of SD and factors associated with SD in IO. We determined the prevalence, severity, and factors associated with SD. Methods Patients with cancer referred for initial outpatient IO consultation in 2017 were eligible. Patient demographics, clinical characteristics, and patient-reported outcomes [Edmonton Symptom Assessment Scale, (ESAS), Measure Yourself Concerns and Wellbeing (MYCaW), PROMIS-10] were retrospectively reviewed. Results 1520 patients were included in the analysis. The majority (70%) were women with breast cancer (42%). 971 (64%) patients reported significant SD with ESAS Sleep ≥ 4, yet only 11% expressed poor sleep as their primary or secondary concern for the IO consultation. The median SD (IQR) was 5 (3,7). ESAS scores for fatigue (adjusted OR 1.16; CI 1.07–1.26, p < 0.001), pain (adjusted OR 1.07; CI 1.00-1.15, p < 0.05), hot flashes (adjusted OR 1.14; CI 1.07–1.22, p < 0.001), well-being (adjusted OR 1.33; CI 1.22–1.46, p < 0.001), and psychological distress score (anxiety and depression) (adjusted OR 1.16; CI 1.01–1.11, P < 0.01) were independently associated with SD in multivariate analysis. Acupuncture was the most frequent intervention prescribed 175 (35%). Other modalities included oncology massage (15%), health psychology (5%) and meditation (1%). Conclusions Although 64% of patients seeking IO consultation reported clinically significant SD, only 11% were seeking integrative approaches for managing SD. ESAS fatigue, hot flashes, well-being, and psychological symptoms were significantly associated with SD.

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Spiritual distress: symptoms, quality of life and hospital utilisation in home-based palliative care

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2021-003090 ◽

2021 ◽

pp. bmjspcare-2021-003090

Author(s):

Andre Cipta ◽

Bethany Turner ◽

Eric C Haupt ◽

Henry Werch ◽

Lynn Reinke ◽

...

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Symptom Burden ◽

Well Being ◽

Spiritual Distress ◽

Home Based ◽

Edmonton Symptom Assessment Scale ◽

Hospital Utilisation ◽

Mental Well Being

ObjectivesThe purpose of this study was to use a spiritual screening question to quantify the prevalence of spiritual distress (SD) in a large cohort of seriously ill patients at admission to home-based palliative care (HBPC) and to examine the associations between SD with symptom burden, quality of life and hospital-based utilisation up to 6 months after admission to HBPC.MethodsData for this cohort study (n=658) were drawn from a pragmatic comparative-effectiveness trial testing two models of HBPC. At admission to HBPC, SD was measured using a global question (0–10-point scale: none=0; mild=1–4; moderate-to-severe=5+); symptoms and quality of life were measured with the Edmonton Symptom Assessment Scale (ESAS) and PROMIS-10. Hospital utilisation was captured using electronic records and claims. Median regression and proportional hazard competing risk models assessed the association between SD with symptoms and quality of life, and hospital utilisation, respectively.ResultsNearly half of the patients/proxies reported some level of SD. Increasing SD was significantly associated with higher symptom burden (increase of 7–14 points on ESAS) and worse mental well-being (decrease of 2.7 to 4.6 points on PROMIS-10-mental) in adjusted models. Compared with patients/proxies who reported no SD, those with at least some level of SD were not at increased risk for hospital-based utilisation over a median follow-up period of 2 months.ConclusionWhile SD is cross-sectionally associated with worse symptoms and mental well-being, it did not predict downstream hospital-based utilisation. Our results highlight the importance of assessing for and managing SD in patients with serious illness.

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Association of physical and psychological symptom burden with time to death among palliative cancer outpatients

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.19523 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 19523-19523

Author(s):

C. Zimmermann ◽

N. Barmala ◽

S. Zarinehbaf ◽

L. W. Le ◽

W. Y. Cheung

Keyword(s):

Psychological Symptom ◽

Symptom Burden ◽

Stage Iv ◽

Symptom Assessment ◽

Physical Symptoms ◽

Initial Assessment ◽

Cancer Site ◽

Shortness Of Breath ◽

Time To Death ◽

Edmonton Symptom Assessment Scale

19523 Background: Patients with terminal cancer have a high symptom burden, which tends to increase as death approaches. Previous studies have assessed the association of symptom burden with time to death (TTD) among inpatients or using baseline data for patients enrolled in a trial. Our purpose was to determine the association of symptom burden with TTD in patients who were followed by an outpatient palliative oncology clinic (OPOC). Methods: Cancer patients seen in the OPOC between January 2005 to June 2006 and who subsequently died were identified from the palliative care database. The last outpatient Edmonton Symptom Assessment Scale (ESAS) score completed in clinic was compared among patients in the last 4 months of life. Multiple linear regression was used to determine the association of ESAS total symptom distress score (SDS), physical subscore (PHS), psychological subscore (PSS) and individual symptom scores with demographic parameters, disease characteristics and TTD. Results: In total, 198 patients were identified. All patients had stage IV cancer, the mean age was 63.8 years (SD 12.9) and 55% were male. Median survival time from initial assessment was 6.6 weeks (range 0.3 to 16.7) and mean SDS was 46.0 (SD 18.0). Sites of cancer included gastrointestinal (36%), lung (12%), genitourinary (10%), hematological (8%), gynecological (8%), breast (7%) and others (19%). There was no significant association between symptom burden and gender, age or cancer site. TTD was significantly associated with SDS (p<0.001) and PHS (p<0.001), but not with PSS (p=0.19). Individual symptoms most strongly associated with TTD were fatigue (p=0.001), appetite (p=0.001), drowsiness (p=0.0005) and shortness of breath (p=0.0008). There was no significant association between TTD and depression (p=0.24) or anxiety (p=0.20). Conclusions: In this outpatient palliative cancer population, the association between TTD and symptoms held true only for physical symptoms, particularly constitutional symptoms and shortness of breath which are amenable to therapy. Symptoms in palliative patients should be rigorously assessed and treated, regardless of prognosis and especially at end-of-life. No significant financial relationships to disclose.

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Caregiver symptom burden assessment using the Edmonton Symptom Assessment System (ESAS): A preliminary report.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.29_suppl.227 ◽

2015 ◽

Vol 33 (29_suppl) ◽

pp. 227-227

Author(s):

Kimberson Tanco ◽

Marieberta Vidal ◽

Joseph Anthony Arthur ◽

David Hui ◽

Gary B. Chisholm ◽

...

Keyword(s):

Psychosocial Factors ◽

Concurrent Validity ◽

Care Center ◽

Performance Status ◽

Prognostic Index ◽

Symptom Burden ◽

Well Being ◽

Physical Symptoms ◽

Assessment System ◽

Cancer Center

227 Background: Regular assessment of caregiver symptom burden during patient visits would allow prompt referral for their care. The ESAS is a multidimensional tool used in patients but not caregivers. The objectives of this study were to determine the feasibility of the ESAS in assessing caregiver symptoms defined as completing 9/12 items, assess caregiver-reported usefulness of its completion, determine the association of symptom scores between patients, caregivers and various clinical and psychosocial factors, and determine concurrent validity with the Zarit Burden Interview-12 (ZBI-12). Methods: A prospective study of 90 patient-primary caregiver dyads in an outpatient Supportive Care Center in a cancer center was conducted. The 12 item ESAS-FS was completed by the dyads with other measures of clinical and psychosocial factors [demographics, cancer diagnosis, co-morbidities, caregiving activities, prognostic index and patient’s performance status]. Results: The ESAS is a feasible tool to assess caregiver symptom burden with 90/90 caregivers [100%] completing at least 9/12 items; 66/90 caregivers [73%] found ESAS useful to report their symptom burden. A significant association was found between ESAS scores of caregivers and patients in depression [p < 0.01], psychosocial items [depression, anxiety, well-being, financial distress, spiritual pain; p < 0.01], and total symptom distress scores [p < 0.01]. Caregiver employment status [p = 0.03] and total caregiver activities [p = 0.04] were significantly associated with total caregiver ESAS scores. There was no significant association between patient and caregiver co-morbidities [p = 0.08], prognostic index [0.07] and performance status [p = 0.26] to total caregiver ESAS scores. Caregivers recommended certain physical symptoms such as pain and nausea may be eliminated. Concurrent validity with ZBI-12 was not achieved [r = 0.53, p = 0.74] suggesting that ESAS measured different caregiver dimensions. Conclusions: The ESAS is a feasible tool to measure caregiver symptoms and was found useful by caregivers. Further research is needed to modify the ESAS based on caregiver’s recommendations and further psychometric studies need to be conducted.

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Use of patient-reported outcomes (PROs) to predict treatment outcomes in patients with advanced cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.29_suppl.186 ◽

2020 ◽

Vol 38 (29_suppl) ◽

pp. 186-186

Author(s):

Aparna Raj Parikh ◽

Emily E. Van Seventer ◽

Madeleine Fish ◽

Kathryn Fosbenner ◽

Katie Kanter ◽

...

Keyword(s):

Treatment Response ◽

Clinical Outcomes ◽

Advanced Cancer ◽

Gastrointestinal Cancer ◽

Symptom Burden ◽

Well Being ◽

Physical Symptoms ◽

Assessment System ◽

Healthcare Use ◽

Predict Treatment Response

186 Background: PROs assessing quality of life (QOL) and physical symptoms often correlate with clinical outcomes in patients (pts) with cancer. Yet, data are lacking about the use of PROs to predict treatment response. We evaluated associations of baseline PROs with treatment response, healthcare use, and survival among pts with advanced gastrointestinal cancer. Methods: We prospectively enrolled pts with metastatic gastrointestinal cancer prior to initiating chemotherapy at Massachusetts General Hospital. At baseline (start of treatment), pts reported their QOL (Functional Assessment of Cancer Therapy General [FACT-G], subscales assess QOL across 4 domains: functional, physical, emotional, social well-being) and symptom burden (Edmonton Symptom Assessment System [ESAS]). Higher scores on FACT-G indicate better QOL, while higher scores on ESAS represent a greater symptom burden. We used regression models to examine associations of baseline PRO scores with treatment response (clinical benefit [CB] or progressive disease [PD] at the time of first scan based on clinical documentation), healthcare use (unplanned hospital admissions), and survival. Results: From 5/2019-3/2020, we enrolled 112 of 131 (85.5% enrollment) consecutive pts (median age = 62.8, 61.6% male, 45.5% pancreatobiliary cancer). For treatment response, 64.3% had CB and 35.7% had PD. Higher ESAS-physical (B = 1.04, p = .027) and lower FACT-G functional (B = 0.92, p = .038) scores at baseline were significant predictors of PD. On the specific ESAS items, pts who experienced PD were more likely to report moderate/severe poor well-being (57.9% vs 29.7%; p = .001), pain (44.7% vs 25.0%; p < .050), drowsiness (42.1% vs 20.3%; p = .024), and diarrhea (23.7% vs 4.7%; p = .008) at baseline. Lower FACT-G total (HR = 0.96, p = .003), FACT-G physical (HR = 0.89, p < .001), FACT-G functional (HR = 0.87, p < .001), and higher ESAS-physical (HR = 1.03, p = .028) scores at baseline were significantly associated with greater risk of hospital admission. Lower FACT-G total (HR = 0.96, p = .009), FACT-G emotional (HR = 0.87, p = .014), as well as higher ESAS-total (HR = 1.03, p = .018) and ESAS-physical (HR = 1.03, p = .040) scores at baseline were significantly associated with greater risk of death. Conclusions: We found that baseline PROs predict treatment response in pts with advanced cancer, namely physical symptoms and functional QOL, in addition to healthcare use and survival outcomes. These findings further support the use of PROs to predict important clinical outcomes, including the novel finding of treatment response.

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Burden and Needs of Patients with Severe GvHD from the Supportive and Palliative Care Perspective—A Literature Review

Cancers ◽

10.3390/cancers13112697 ◽

2021 ◽

Vol 13 (11) ◽

pp. 2697

Author(s):

Freya Wenzel ◽

Anne Pralong ◽

Udo Holtick ◽

Christoph Scheid ◽

Marco Herling ◽

...

Keyword(s):

Palliative Care ◽

Patient Group ◽

Symptom Burden ◽

Standard Of Care ◽

Well Being ◽

Physical Symptoms ◽

Curative Intent ◽

Hematopoietic Stem ◽

Spiritual Well Being ◽

And Function

Graft-versus-host disease (GvHD) is a frequent, and often life-threatening, complication after an allogeneic, hematopoietic stem cell transplantation (allo-SCT). It can appear in an acute or a chronic form and presents different grades of severity. Particularly, the severe forms of GvHD are often responsible for a change of the curative intent for allo-SCT into a palliative goal of care. For this non-systematic review, we conducted a focused literature search in the MEDLINE database via PubMed to examine whether patients with severe forms of GvHD might have special needs and burdens from a supportive and palliative care perspective. To draw a comprehensive picture of this patient group, we included findings on quality of life (QoL) and physical symptoms and function as well as psychological and spiritual well-being. In most domains, patients with severe forms of GvHD showed greater impairment and a higher symptom burden compared to patients with milder forms of GvHD. However, we could not identify any studies that specifically investigated patients with severe forms of GvHD. Further research in this field is necessary to guarantee the highest standard of care for this very special patient group.

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Couples symptom burden in oncology care: Perception of self and the other.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.5_suppl.213 ◽

2017 ◽

Vol 35 (5_suppl) ◽

pp. 213-213

Author(s):

Gabriel Lopez ◽

Kathrin Milbury ◽

Yisheng Li ◽

Minxing Chen ◽

Casey Dutton ◽

...

Keyword(s):

Global Health ◽

Financial Distress ◽

Psychological Symptoms ◽

Symptom Burden ◽

Symptom Assessment ◽

Physical Symptom ◽

Physical Symptoms ◽

Psychological Stressors ◽

Edmonton Symptom Assessment Scale ◽

Symptom Assessment Scale

213 Background: Cancer survivors and their caregivers have symptoms that wax and wane over time and are interrelated. We report on the results of a communication survey exploring symptom burden in couples presenting for care in an integrative oncology (IO) clinic. Methods: Couples were approached for participation while waiting for an IO service (Physician Consultation, Massage, Acupuncture, Physical Therapy, Nutrition). 50 patients and their partner completed the Edmonton Symptom Assessment Scale (ESAS; 0-10, 10 worst). Patient and partner each completed two ESAS forms: one for themselves and one for their perception of the other’s symptoms. Each also completed a Global Health scale (PROMIS 10). ESAS distress subscales analyzed included Psychological (PSS) and Physical (PHS). Paired t-tests were used to examine all measures. Results: Patients (58% female) had most frequent cancer diagnoses of breast (22%) and gastrointestinal (18%). Patients rated their own physical symptoms of Fatigue (p = 0.002), Nausea (p < 0.001), Drowsiness (p = 0.032), Appetite (p = 0.008), and Shortness of Breath (p = 0.001) significantly higher than their partner’s rating of their symptoms. Patient self-rating for psychosocial symptoms of anxiety and depression was not significantly different from partner rating of patient symptoms. Partners were more accurate rating psychological symptoms (ESAS PSS, patient 3.89 vs partner 3.72, p = 0.836) and less accurate interpreting physical symptoms (ESAS PHS, patient 16.43 vs partner 9.94, p < 0.001). Except for Sleep, Financial Distress, and Spiritual Pain, partners rated all their own symptoms significantly lower compared to patient’s rating of them (all p’s < 0.001). Patients reported significantly lower global health (36.9 vs 42.9, p < 0.001) and physical health (16.6 vs 20.2, p < 0.001); no differences were observed for mental health for patients vs caregivers (14.2 vs 15.12, p = 0.1). Conclusions: Our findings suggest that partners may better perceive psychological stressors expressed by patients but may be less sensitive to physical symptoms. Interventions aimed at assisting caregivers in better understanding patient physical symptom burden are warranted.

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