scholarly journals Symptom Burden in Transplant Ineligible Patients with Newly Diagnosed Multiple Myeloma: A Population-Based Study of Patient-Reported Outcomes

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 30-31
Author(s):  
Hira S Mian ◽  
Gregory R Pond ◽  
Branavan Sivapathasundaram ◽  
Tanya M. Wildes ◽  
Jonathan Sussman ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Patient Reported Outcomes ◽  
Symptom Burden ◽  
Well Being ◽  
Population Based ◽  
First Year ◽  
Newly Diagnosed ◽  
Population Based Study ◽  
Patient Reported ◽  
One Year

Introduction Multiple myeloma (MM) is an incurable malignant plasma cell disease with a median age at diagnosis of 70 years, making it a disease of older patients. Although there has been much progress made in the therapeutics of MM, there is a paucity of data with regards to the symptoms experienced by these patients. Patient reported outcomes (PROS) represent an opportunity to both understand the magnitude as well as the temporal trend of this symptom burden. In 2007, routine prospective collection of patient-reported Edmonton Symptoms Assessment System (ESAS) scores during all outpatient cancer clinic visits was initiated in Ontario, Canada. The ESAS is a validated and reliable tool that assesses the severity of nine common symptoms: well-being, pain, tiredness, anxiety, depression, drowsiness, lack of appetite, nausea and shortness of breath. The study of longitudinal data from an administrative data base provides a unique opportunity to understand the symptom burden experienced by MM patients in the 'real-world' at a population level. Methods We conducted a retrospective population-based study using administrative data from the Institute of Clinical Evaluative Sciences (ICES), which maintains a central database of health records for all patients in the publicly funded health care system for the province of Ontario, Canada. All patients with newly diagnosed multiple identified using the ICD-O-3 code 9732 (Multiple Myeloma), who received treatment, but no transplant in the first year, between the years Jan 2007-Dec 2018, were identified. The main outcome of interest was an ESAS score of ≥4 which has been shown to represent clinically significant moderate to severe symptom burden, within the first 12 months following MM diagnosis. Logistic regression was used to assess the association between baseline factors identified a priori and moderate to severe symptoms for each domain. Results A total of 4611 transplant ineligible patients with newly diagnosed myeloma were identified between the years 2007-2018. Of these, 2876 (62.3%) with at least one ESAS score following diagnosis were included in this analysis. This represented 27,701 unique ESAS assessments recorded during the first year, which were used to form the cohort. Baseline characteristics for transplant ineligible patients with one or more ESAS are shown in Table I. Trajectory for moderate to severe symptoms in each month following diagnosis is shown in Figure 1. A high proportion of the cohort reported moderate to severe symptoms at diagnosis, with tiredness (64%) and impaired well-being (60%) being among the most prevalent and nausea being the least prevalent (13%). Most symptoms decreased over the first year, with the largest decline happening in the first 3 months. One year following diagnosis, there continued to be a substantial burden of symptoms, with over 25% of the cohort reporting at least one or more of the following moderate-severe symptoms: tiredness, pain, impaired well-being, drowsiness or loss of appetite. Self-reported depression rates marginally decreased over time; however, at the end of one year, 18% of cohort still reported moderate to severe depression. On multivariable analysis, younger age, female sex, urban geographic location, poor socioeconomic status, an earlier diagnosis year, myeloma defining end-organ damage and non-teaching hospital were associated with a higher odds of reporting moderate to severe symptoms. Conclusion Our results demonstrate that there is considerable symptom burden during the first year following MM diagnosis, with tiredness, impaired well-being and pain being the most common. Although symptoms improve over time, a significant proportion of patients continue to experience moderate to severe symptoms one-year post diagnosis. This study represents the largest population-based cohort study done to date in symptom burden among patients with MM. Future studies aimed at targeted intervention are needed early in the disease course in order to alleviate symptoms burden for at-risk patient groups. Disclosures Mian: Takeda: Consultancy, Honoraria; Celgene: Consultancy; Janssen: Consultancy, Honoraria; Amgen: Consultancy, Honoraria; Sanofi: Consultancy. Pond:Roche Canada: Other; Astra Zeneca: Consultancy; Takeda: Honoraria. Wildes:Janssen: Research Funding; Seattle Genetics: Consultancy; Carevive Systems: Consultancy.

scholarly journals Trajectory of Symptoms after Autologous Stem Cell Transplant Among Patients with Multiple Myeloma: A Population-Based Study

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 1-2
Author(s):  
Hira S Mian ◽  
Gregory R Pond ◽  
Tanya M. Wildes ◽  
Branavan Sivapathasundaram ◽  
Jonathan Sussman ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Stem Cell Transplant ◽  
Symptom Burden ◽  
Well Being ◽  
Autologous Stem Cell Transplant ◽  
Population Based ◽  
First Year ◽  
Cell Transplant ◽  
Population Based Study

Introduction Autologous stem cell transplant (ASCT) remains the standard of care for eligible patients with multiple myeloma (MM). There is a paucity of data with regards to the symptom burden experienced by patients undergoing ASCT. In 2007, routine prospective collection of patient-reported outcome (PROs), Edmonton Symptoms Assessment System (ESAS), was initiated in all outpatient cancer clinics in Ontario, Canada. The ESAS is a validated and reliable tool which assess the severity across nine common symptoms: well-being, pain, tiredness, anxiety, depression, drowsiness, lack of appetite, nausea and shortness of breath. This administrative data provides a unique opportunity to the understand the symptom burden experienced by MM patients undergoing ASCT in the real world at a population level. Methods We conducted a retrospective population-based study using administrative data from the Institute of Clinical Evaluative Sciences (ICES), which maintains a central database of health records for all patients in the publicly funded health care system for the province of Ontario, Canada. All patients with newly diagnosed MM using the ICD-O-3 code 9732 (Multiple Myeloma), who received an ASCT within one year of diagnosis, between Jan 2007-Dec 2018, were identified. The main outcome of interest was an ESAS score of ≥4 each month, which has been shown to represent clinically significant moderate to severe symptom burden. Results A total of 2925 patients with myeloma were identified between 2007-2018. 158 patients who underwent a tandem ASCT and 956 patients who did not have an ESAS score recorded within a year following ASCT were excluded. Among 1969 (67.3%) evaluable patients, there were 12,820 unique ESAS assessments recorded during the first year which were used to form the cohort. The median number of ESAS surveys filled out by each patient was 5 (IQR 2-10) and the median time from transplant to first ESAS score recorded was 34 days (IQR 18-84). Baseline characteristics for the patients are shown in Table 1. The trajectory of symptoms following ASCT is shown in Figure 1. Tiredness, impaired well-being and lack of appetite were the three most common symptoms after ASCT and improved over the year. Psychosocial symptoms including anxiety and depression were present in approximately 20% of the cohort and only marginally improved during the year following ASCT. Additional analyses to assess the impact of baseline variables on high symptom burden is currently in progress. Conclusion This study represents the largest population-based cohort study done to date evaluating symptoms burden in patients with MM undergoing ASCT. Our results demonstrate that there is considerable symptoms burden during the first year following ASCT among MM patients. While physical symptoms improved over time, psychosocial symptoms remained persistent with only marginal improvement. Future studies aimed with tailored interventions are needed in order to address symptoms burden for patient groups at highest risk. Disclosures Mian: Amgen: Consultancy, Honoraria; Sanofi: Consultancy; Celgene: Consultancy; Janssen: Consultancy, Honoraria; Takeda: Consultancy, Honoraria. Pond:Takeda: Honoraria; Astra Zeneca: Consultancy; Roche Canada: Other. Wildes:Seattle Genetics: Consultancy; Janssen: Research Funding; Carevive Systems: Consultancy.

Predictors of electronic patient-reported outcomes use in the survivorship setting.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e14038-e14038
Author(s):  
Bridgette Thom ◽  
Stacie Corcoran ◽  
Jessica A. Lavery ◽  
Leon Sarpong ◽  
Alexandria Woodside ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Symptom Burden ◽  
First Year ◽  
Patient Portal ◽  
Cohen’S Kappa ◽  
Cohen's Kappa ◽  
Patient Reported ◽  
One Year ◽  
Future Work ◽  
At Home

e14038 Background: Patient-reported outcomes (PRO) offer insight into patient perception of health and symptom burden. Despite a shift toward electronic PRO (ePRO), optimal administration methods are unclear. Our institution recently began ePRO collection in survivorship clinics: patients are invited via email to complete a health survey on our online patient portal prior to annual visits, enabling clinician review of symptoms in advance of the visit. Patients who do not complete an ePRO survey at home are offered an iPad or paper survey at visit check-in. In the first year of ePRO, 87 patients inadvertently submitted multiple responses to the questionnaire, across two modalities. This study aimed to 1) assess determinants of ePRO completion across modalities (portal, iPad, paper); and, 2) among patients who submitted multiple surveys, compare consistency of responses in surveys completed within 30 days of each other. Methods: We reviewed records for 10194 patients seen in breast, thoracic, colorectal, and gynecologic survivorship clinics over one year. Demographics, disease/treatment details, and PRO responses (symptoms, health behaviors, etc.) were extracted. For aim 1, we used multivariate regression to determine predictors of completion method. For aim 2, we calculated Cohen’s kappa coefficients to compare responses based on completion modality. Results: Most patients (65.6%) completed the survey on an iPad in clinic; 16.7% on the portal, 17.7% on paper in clinic. Younger age (p < .001), white race (p < .001), less fatigue (p = .01), and English as primary language (p < .001) were associated with portal use in multivariate analyses. In general, Cohen’s Kappa analyses revealed high agreement between surveys. Conclusions: Our findings highlight demographic gaps in ePRO acceptance. Although most patients completed an ePRO (portal or iPad), few completed it at home in advance of their visit, which has implications for clinic flow and clinician preparation for visits. However, our finding of consistent symptom reporting across mode and location of completion is reassuring. Future work should seek to improve comfort with ePRO completion at home among groups less likely to accept it and explore the implications of symptom burden on ePRO acceptance.

scholarly journals Is Symptom Burden Associated with Health Care Utilization: A Longitudinal Population-Based Cohort Study of Transplant Ineligible Patients with Newly Diagnosed Multiple Myeloma

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 116-116
Author(s):  
Hira S Mian ◽  
Rinku Sutradhar ◽  
Gregory R Pond ◽  
Branavan Sivapathasundaram ◽  
Anita D'Souza ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Symptom Burden ◽  
Well Being ◽  
Population Based ◽  
Care Utilization ◽  
First Year ◽  
Advisory Committees ◽  
Symptom Scores ◽  
One Year

Abstract Introduction Transplant ineligible patients with newly-diagnosed multiple myeloma (TI NDMM) have high rates of health care utilization [emergency department visits and/or unplanned hospitalization (ED/hosp)] due to a combination of co-morbidities/frailty, disease manifestations and toxicities of anti-MM treatment. Understanding and optimizing unplanned health care utilization represents an important step in delivering person-centred care in MM. Patient reported outcomes (PROs) may represent one opportunity for predicting health care utilization. Databases within Ontario, Canada represent a unique opportunity to evaluate this association due to the implementation of a standardized population-wide PRO tool (the Edmonton Symptoms Assessment System [ESAS]). ESAS scores have been completed by patients during all outpatient cancer clinic visits since 2007. The ESAS is a validated and reliable tool that assesses the severity of nine common symptoms: well-being, pain, tiredness, anxiety, depression, drowsiness, lack of appetite, nausea and shortness of breath. Patients score these on a rating scale from 0 (no symptom) to 10 (worse possible symptom). The objective of our study was to evaluate the association between PROs (ESAS score) and the subsequent 14-day risk of ED/hosp among TI NDMM patients in the first year following diagnosis. Methods We conducted a retrospective population-based study using administrative data from ICES (previously known as the Institute of Clinical Evaluative Sciences), which maintains databases of health records for all patients in the publicly funded health care system in Ontario, Canada. All patients with NDMM identified using the ICD-O-3 code 9732 (MM), who received treatment without transplant in the first year between Jan 2007-Dec 2018 were included. Patients with no documented ESAS score within one year following diagnosis were excluded. The main outcome of interest was the occurrence of at least one ED/hosp within 14 days of an ESAS assessment in the first year following diagnosis. The main exposure variable was ESAS score (individual score for each of the nine symptoms and total score of all the nine symptoms [t-ESAS]) at each index date. A logistic regression model was used to assess the association of ESAS score and subsequent 14-day ED/hosp. A generalized estimating equations approach was used to account for patient level clustering, arising from multiple ESAS assessments taken on the same patient (over the first year after diagnosis). Results There were 2876 TI NDMM patients identified completing a total of 17,353 ESAS assessments. Baseline characteristics of the cohort are shown in Table 1. Tiredness, poor well-being and pain were the three most common severe symptoms present in 19.6%, 12.4% and 12.2% of the assessments, respectively. With regards to health care utilization, there were a total of 1755 ED/hosp visits in 1172/2876 (40.8%) TI NDMM patients within one year following diagnosis in our cohort. The proportion of patients with ED/hosp within 14 days of the ESAS assessment are outlined in Figure 1. There was an incremental increase in ED/hosp with increasing ESAS scores (higher score indicative of worse symptoms) for each individual symptom. A similar trend was noted for those with increasing t-ESAS scores with a 14-day ED/hosp event rate of 31.3% for those with a maximum score of 90 compared with 5.5% for those with a score of 0. Univariable and multivariate odds for ED/hosp are presented in Table 2. All nine symptom scores and t-ESAS were associated with an increased risk of ED/hosp visits. After controlling for confounders, individual symptoms (pain, tiredness, lack of appetite, shortness of breath and impaired well-being) and t-ESAS remained positively associated with ED/hosp. Conversely, self-reported depression was associated with decreased risk of ED/hosp (odds ratio 0.96 per unit increase, 95% Cl 0.93-0.99, p=0.01). Conclusion Our findings represent the largest study to date demonstrating that a PRO measure of symptom burden is associated with health care utilization in TI NDMM. Even after controlling for baseline factors, ED/hosp remained positively associated with higher ESAS symptom scores. The results of this study may help clinicians identify patients at high risk for ED/hosp. Further studies are required to understand whether targeted intervention aimed at reducing this symptom burden may help decrease ED/hosp usage. Figure 1 Figure 1. Disclosures Mian: BMS: Consultancy, Honoraria; Sanofi: Consultancy, Honoraria; Janssen: Consultancy, Honoraria, Research Funding. Pond: Takeda: Membership on an entity's Board of Directors or advisory committees; Astra-Zeneca, Merck, Profound Medical: Consultancy; Roche Canada: Current holder of individual stocks in a privately-held company. D'Souza: Sanofi, Takeda, Teneobio, CAELUM, Prothena: Research Funding; Janssen, Prothena: Consultancy; Imbrium, Pfizer, BMS: Membership on an entity's Board of Directors or advisory committees. Wildes: Carevive: Consultancy; Seattle Genetics: Consultancy; Sanofi: Consultancy; Janssen: Consultancy.

scholarly journals Energy level and fatigue after surgery for thyroid cancer: A population-based study of patient-reported outcomes

Surgery ◽  
2020 ◽  
Vol 167 (1) ◽  
pp. 102-109 ◽  
Author(s):  
David T. Hughes ◽  
David Reyes-Gastelum ◽  
Kevin J. Kovatch ◽  
Ann S. Hamilton ◽  
Kevin C. Ward ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Energy Level ◽  
Patient Reported Outcomes ◽  
Population Based ◽  
Population Based Study ◽  
Patient Reported

Improved Prognosis in Multiple Myeloma-a Population Based Study on 13,376 Patients Diagnosed in Sweden 1973–2001.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 2408-2408
Author(s):  
Sigurdur Y. Kristinsson ◽  
Ola Landgren ◽  
Paul Dickman ◽  
Asa Derolf ◽  
Magnus Bjorkholm
Keyword(s):  
Multiple Myeloma ◽  
Excess Mortality ◽  
Relative Survival ◽  
Population Based ◽  
Age At Diagnosis ◽  
University Hospital ◽  
Calendar Period ◽  
Population Based Study ◽  
Younger Age ◽  
One Year

Abstract Background: Over the last decades there have been advances in the treatment of patients with multiple myeloma (MM) and prognosis has improved with the introduction of new treatment strategies. However, few studies have addressed the issue which patients benefit most from these therapeutic changes over the years. Aims: To evaluate relative survival in all diagnosed MM patients in Sweden 1973–2001 and relate the changes to age, sex and type of hospital where diagnosis was made. Methods: All patients with MM notified to the Swedish Cancer Register in 1973–2001 were followed up by record linkage to the nationwide Cause of Death Register. Survival analyses were performed by obtaining relative survival (RS) defined as the ratio of observed versus expected survival. The study period was divided arbitrarily to four calendar periods: 1973–1979, 1980–1986, 1987–1993, and 1994–2002. Patients were grouped according to age at diagnosis (0–40, 41–50, 51–60, 61–70, 71–80, and 80+), sex, and hospital category. RS was estimated using SAS (Cary, NC, USA) and excess mortality modelled using Poisson regression. Results: A total of 13,376 patients (7,114 males and 6,262 females, mean age 69.8 years, and 32% diagnosed at a university hospital) were diagnosed with MM in Sweden between January 1st 1973 and December 31st 2001. The overall one-year RS estimates were 73%, 78%, 80%, and 81%, respectively, for the four calendar periods. The overall five-year RS was 31%, 32%, 34%, and 36% and the ten-year RS remained stable at 12%, 11% 13% in the first three periods; ten-year RS could not be calculated for the last calendar period. The increase in one-year RS was observed in all age categories over the four calendar periods, while the increase in five-year RS was restricted to patients <70 years. Younger age at onset was associated with a superior survival in all calendar periods. Differences in survival by age at diagnosis and calendar period were highly statistically significant (p<0.0001). Females had a superior 1- (p=0.002), 5- (p=0.024), and 10-year RS (p=0.019) compared to males, after adjusting for age and period. Patients diagnosed at university hospitals had superior 5- and 10-year RS (p=0.007) but not 1-year RS. Summary/conclusions: The present study shows an improved prognosis over time in a population-based study including > 13,000 MM patients diagnosed during a 29-year period. Of interest is that even one-year RS has improved in all age groups over the whole study period. Increase in five-year RS was only observed in patients aged <70 years. The ten-year RS did not improve over the first 20 years and could not be estimated for patients diagnosed in the last period. Younger age at diagnosis was associated with superior one-, five- and ten-year RS in all calendar periods. Females had a significantly better survival than males. A significant difference in survival was seen according to type of hospital, with patients diagnosed at a university hospital surviving longer. In conclusion, the results show that survival of MM patients has improved during the study period. However, long-term survival has not improved significantly. Males, elderly patients and patients diagnosed during early calendar periods experienced higher excess mortality.

Multiple Myeloma and Infections: A Population-Based Study Based On 9,610 Multiple Myeloma Patients

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 945-945
Author(s):  
Cecilie Blimark ◽  
Ulf-Henrik Mellqvist ◽  
Ola Landgren ◽  
Magnus Björkholm ◽  
Malin L Hultcrantz ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Bacterial Infections ◽  
Viral Infections ◽  
Normal Population ◽  
Large Population ◽  
Population Based ◽  
First Year ◽  
Population Based Study ◽  
Prophylactic Measures ◽  
Increased Risk

Abstract Abstract 945 Background Infections are a major cause of morbidity and mortality in patients with multiple myeloma (MM). No large population-based evaluation has been made to assess the risk of infections in MM patients compared to the normal population. Therefore, we performed a large study, using population-based data from Sweden, to estimate the risk of bacterial and viral infections among 9,610 MM patients compared to 37,718 matched controls. Methods We gathered information on all MM patients reported to the nationwide Swedish Cancer Registry from 1988 to 2004, with follow-up to 2007. For each MM patient, four population-based controls (matched by age, sex, and county of residence) were identified randomly from the Swedish population database. Information on occurrence and date of infections was obtained from the centralized Swedish Patient registry that captures information on individual patient-based discharge diagnosis from inpatient (with very high coverage) and outpatient care (since 2000). Cox proportional hazard models were used to estimate the overall, one- and five-year risk of infections. In addition, the effect of gender, age and calendar period of diagnosis was evaluated. Hazard ratios (HRs) and confidence intervals (CIs) were calculated for the occurrence of different infections. Results Overall, MM patients had a 6-fold (HR= 5.9; 95% CI=5.7-6.1) risk of developing any infection compared to matched controls (Figure). The increased risk of developing a bacterial infection was 6-fold (HR=5.9; 95%; CI=5.6-6.1), and for viral infections 9-fold (HR=9.0; 95% CI=8.0-10.1), compared to controls. More specifically, MM patients had an increased risk (p<0.05) of the following bacterial infections: cellulitis (HR=2.6; 95% CI =2.2-3.1), osteomyelitis (HR=3.0; 95% CI 2.0–4.4), endocarditis (HR=4.4; 95% CI 2.9–6.6), meningitis (HR=14.5; 95% CI 9.1–23.0), pneumonia (HR=6.2; 95% CI 5.9–6.5), pyelonephritis (HR=2.5; 95% CI 2.1–3.0), and septicaemia (HR=13.7; 95% CI 12.5–14.9) and for the viral infections influenza (HR=5.4; 95% CI 4.4–6.7) and herpes zoster (HR=12.8; 95% CI 10.5–15.5). The risk of infections was highest during the first year after diagnosis; the risk of bacterial infections was 11-fold (95% CI 10.7–12.9) and the risk of viral infections was 18-fold (95% CI 13.5–24.4) higher compared to controls during the first year after diagnosis. MM patients diagnosed in the more recent calendar periods had significantly higher risk of infections, reflected in a 1.6-fold (95% CI=1.5-1.7) and 2-fold (95% CI=1.9-2.1) increased risk in patients diagnosed during 1994–1999 and 2000–2004, compared to patients diagnosed 1986–1993. Females had a significantly lower risk of infections compared to males (p<0.001). Increasing age was significantly associated with a higher risk of infections (p<0.001). Discussion In this large population-based study including over 9,000 MM patients and 35,000 matched controls, we found that bacterial and viral infections represent a major threat to myeloma patients. We found the risk of specific infections like pneumonia, and septicemia to be over ten times higher in patients than in controls during the first year after MM diagnosis. Importantly, the risk of infections increased in more recent years. The effect on infectious complications due to novel drugs in the treatment of MM needs to be established and trials on prophylactic measures are required. Disclosures: Mellqvist: Janssen, Celgene: Honoraria.

Differences In Community and Academic Practice Patterns For Newly Diagnosed Myelodysplastic Syndromes (MDS) Patients In Minnesota: A Population Based Study

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2798-2798 ◽  
Author(s):  
Daniel Pease ◽  
Julie A Ross ◽  
Phuong L. Nguyen ◽  
Betsy Hirsch ◽  
Adina Cioc ◽  
...  
Keyword(s):  
High Risk ◽  
Supportive Care ◽  
Practice Patterns ◽  
Risk Group ◽  
Population Based ◽  
Low Risk ◽  
Risk Scores ◽  
First Year ◽  
Newly Diagnosed ◽  
Population Based Study

Abstract Introduction Expanding treatment options for MDS have changed therapeutic decision-making for clinicians. To better characterize therapeutic choices in newly diagnosed MDS, we report the practice patterns captured during the first year of MDS diagnosis for patients enrolled in our statewide population-based study. We highlight a comparison of treatment in community and academic centers. Methods Adults in Minnesota with MDS (AIMMS) is a statewide prospective population-based study conducted by the University of Minnesota (UMN), Mayo Clinic, and Minnesota Department of Health. Starting in April 2010, all newly diagnosed adult cases (ages 20+) of MDS were invited to participate. After patient enrollment, central review was performed consisting of independent hematopathology and cytogenetic review coupled with oncologist chart review assigning prognostic risk scores [International Prognostic Scoring System (IPSS) and IPSS-R (Revised)] and abstracting treatment exposures. All enrolled patients with one year follow-up were included in this analysis. Treatment was divided into supportive, active, transplant, or other. Supportive care included observation, growth factors, and transfusions. Active care included azacitidine, decitabine, lenalidomide, or 7+3 chemotherapy. Academic centers were defined as the UMN and Mayo Clinic; all other centers were designated as community based practices. Results The median patient age was 73 years, with 68% males. IPSS and IPSS-R risk scores were calculated for 100% and 97% of patients, respectively. Treatment choices stratified by IPSS risk group showed 89% low risk, 53% INT-1, 31% INT-2, and 13% high risk with supportive care; active and transplant strategies were utilized for 9% low risk, 44% INT-1, 64% INT-2, and 88% high risk. INT-1 in the community received 70% supportive treatment, in academic 35%. Active treatment for INT-1 was 30% in community and 45% in academic. Community INT-2 received supportive care in 45% of cases, in academic 23%. Transplants were limited to academic centers, with the highest rate in INT-2 at 34%. Among community diagnoses, 100% of high risk, 52% INT-2, 26% INT-1, and 13% low risk were referred to an academic center. Comparison of age <65 and 65+ years showed 83% of transplants occurred in those <65. INT-2/high risk group patients <65 received 95% active therapy or transplant, compared to 51% of those 65+. Discussion This prospective, population based study provides a well-defined patient cohort based on central review of pathologic and clinical data. Evaluation of practice patterns during the first year after diagnosis showed higher utilization of active and transplant treatment strategies as IPSS risk score increased. Further, compared to community, higher utilization occurred for patients at academic centers, suggesting more aggressive treatment in these settings. Age was also a predictor of treatment choice. In addition, referral patterns followed IPSS score. Whether these treatment differences are driven by patient preference and/or translate into improved disease control and decreased mortality requires continued prospective analysis and will be detailed in future reports. Disclosures No relevant conflicts of interest to declare.

Patient-Reported Symptom Burden as a Predictor of Emergency Department Use and Unplanned Hospitalization in Head and Neck Cancer: A Longitudinal Population-Based Study

2021 ◽  
pp. JCO.20.01845
Author(s):  
Christopher W. Noel ◽  
Rinku Sutradhar ◽  
Haoyu Zhao ◽  
Victoria Delibasic ◽  
David Forner ◽  
...  
Keyword(s):  
Emergency Department ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Symptom Burden ◽  
Population Based ◽  
Assessment System ◽  
Emergency Department Use ◽  
Population Based Study ◽  
Patient Reported

PURPOSE: To determine the association between patient-reported symptom burden and subsequent emergency department use and unplanned hospitalization (ED/Hosp) in a head and neck cancer (HNC) patient population. METHODS: This was a population-based study of patients diagnosed with HNC who had completed at least one outpatient Edmonton Symptom Assessment System (ESAS) assessment between January 2007 and March 2018 in Ontario, Canada. Logistic regression models were used to determine the relationship between outpatient ESAS scores and subsequent 14-day ED/Hosp use. A generalized estimating equation approach with an exchangeable correlation structure was incorporated to account for patient-level clustering RESULTS: There were 11,761 patients identified, completing a total of 73,282 ESAS assessments and experiencing 5,203 ED/Hosp events. Six of the nine ESAS symptom scores were positively associated with ED/Hosp use, with pain, appetite, shortness of breath, and tiredness demonstrating the strongest associations. A global ESAS score was calculated by selecting the highest individual symptom score (h-ESAS). Among patients reporting a maximum h-ESAS score of 10, 15.1% had an ED/Hosp event within 14 days compared with 1.5% for those with the lowest possible score of zero. In adjusted analysis, the odds of ED/Hosp use increased with h-ESAS (1.23 per one-unit increase [95% CI, 1.22 to 1.25]). When treated as a categorical variable, patients with the maximum h-ESAS score of 10 had 9.23 (95% CI, 7.22 to 11.33) higher odds of ED/Hosp use, relative to the minimum score of zero. CONCLUSION: ESAS scores are strongly associated with subsequent ED/Hosp events in patients with HNC. Clinician education around how ESAS data might inform patient care may enhance symptom detection and management.

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