In search of the optimal outcome measure for patients with advanced cancer and gastrointestinal obstruction: A qualitative research study.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 100-100 ◽  
Author(s):  
Brian D. Badgwell ◽  
Loretta A. Williams ◽  
Eduardo Bruera
Keyword(s):  
Qualitative Research ◽  
Advanced Cancer ◽  
Symptom Burden ◽  
Psychometric Testing ◽  
Symptom Assessment ◽  
Symptom Inventory ◽  
Gastrointestinal Obstruction ◽  
Item List ◽  
Md Anderson ◽  
Panel Rating

100 Background: Gastrointestinal obstruction (GIO) is the most common indication for palliative surgical consultation in patients with advanced cancer. The purpose of this study was to delineate the symptom burden and experience of patients with GIO. Methods: Twenty patients with advanced cancer and GIO described symptoms at the time of surgical consultation. We used content analysis of interview transcripts and symptoms were ranked by frequency and compared to a general symptom assessment survey (MD Anderson Symptom Inventory). Results: Malignancy type included colorectal (N = 9), gastric (N = 4), urothelial/renal (N = 3), and other (N = 4), while site of obstruction was small bowel in 11 (55%), gastric outlet in 3 (15%), and large bowel in 6 (30%). Thirteen patients (65%) had received chemotherapy within 6 weeks. Imaging evidence of a primary/recurrent tumor, carcinomatosis, or ascites was documented in 13 (65%), 11 (55%), and 16 (80%) patients, respectively. Thirty symptoms were identified on qualitative interviewing. MD Anderson Symptom Inventory symptoms of pain, nausea, and vomiting were frequently noted. Frequently mentioned GIO-specific symptoms included bloating, cramping, not having a bowel movement, and inability to eat. Conclusions: Qualitative research methodology can identify symptoms of importance to patients which can be used to assess improvement after treatment of GIO. Expert panel rating will be used to develop the final symptom item list prior to psychometric testing of the survey.

Program development through compilation of patient self-reported symptom burden.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 78-78
Author(s):  
Diane Denny ◽  
Brandon Bosch ◽  
Kayla Alston ◽  
Maurie Markman
Keyword(s):  
Program Development ◽  
Assessment Tool ◽  
Symptom Burden ◽  
Clinical Intervention ◽  
Assessment Instrument ◽  
Free Text ◽  
Cancer Type ◽  
National Network ◽  
Symptom Inventory ◽  
Md Anderson

78 Background: Cancer Treatment Centers of America, (CTCA) is a national network of five hospitals that specialize in the treatment of patients fighting complex or advanced-stage cancer. The Symptom Inventory Tool (SIT) is an assessment tool that captures the patients’ perceived symptom burden for real time clinical intervention and provides longitudinal data to demonstrate how effectively we meet our patient’s needs, from the point of no intervention (baseline) and every 21 days or greater. The SIT is comprised of 27 questions utilizing the MD Anderson Symptom Inventory tool, a validated assessment instrument with 8 questions added and a free text box by CTCA. The SIT became an integral part of patient care at CTCA in September 2012. Methods: A multidisciplinary team convened to evaluate how best to deliver the SIT data to facility leadership to assist with program development. The data needed to perform each calculation was obtained using analytical software that interfaces the database, electronic health record, and cancer registry. A Quality Research Associate prepares the operational summary providing a monthly update for the leadership at each facility with data included for the previous month, cumulatively for the facility, and cumulatively for the network. Results: The summary includes mean time to complete an assessment, assessments by timeframe (i.e. baseline, 2nd, 3rd assessments, etc.), gender and age percentages, and patients categorized by cancer type. The top three average scoring symptoms and interference issues by baseline, 2nd, and 3rd assessment are highlighted along with the top areas of improvement and diminishment in score defined by a change of 2 or more points reflecting clinical relevance. The top areas scored at 8 or greater that improved and the top areas where patients continued to score at 8 or greater on return are presented to focus upon the most severe needs. Graphs and tables are accompanied by explanation. Conclusions: In addition to consistency in presentation of the data across centers, the SIT operational summary provides visibility and insight on key emerging trends. Meaningful discussion of programmatic opportunities for focus on the most problematic and severe symptom by patient group has occurred.

The influence of a cachexia clinic on palliative care integration in oncology.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 124-124
Author(s):  
Diane Portman ◽  
Sarah Thirlwell ◽  
Kristine A. Donovan
Keyword(s):  
Palliative Care ◽  
Weight Loss ◽  
Advanced Cancer ◽  
Symptom Burden ◽  
Symptom Assessment ◽  
Cancer Center ◽  
Edmonton Symptom Assessment Scale ◽  
Symptom Assessment Scale ◽  
The Impact

124 Background: Appetite and weight loss are common in patients with advanced cancer and specialized cachexia clinics have been established to address these symptoms. Given the association between anorexia/cachexia and other adverse symptoms, these patients may also benefit from specialty level palliative care (PC). However, referral to outpatient specialty level PC is often delayed or does not occur. We sought to examine the prevalence of other factors associated with appetite and weight loss in patients with advanced cancer and the impact of a specialized cachexia clinic on identification and treatment of other PC needs. Methods: The records of patients referred by their Oncologist to the cachexia clinic of a cancer center from August 2016 to June 2017 were reviewed retrospectively. Subjects who had been referred to PC by their Oncologist were excluded. Patients had been assessed for symptom burden using the Edmonton Symptom Assessment Scale (ESAS-r). Patients identified with PC needs had been referred to the PC clinic for follow-up within 30 days after cachexia clinic consultation. Results: Thirty subjects were evaluated in the cachexia clinic (average age 68 years; 63% female). The predominant diagnosis was lung cancer (70%). An average of 6 symptoms per patient were in the moderate to severe range on ESAS, excluding appetite. Depression, fatigue and pain were most common. The average cachexia clinic total ESAS score was 51.61. Only 17% of patients had completed advance directives. Ninety-three % of patients were referred to PC and 68% were seen. The average number of PC visits was 2.79. Within the PC clinic, advance directive completion increased to 37%, goals of care discussion occurred with 50% and 17% received hospice referrals. At the most recent follow-up in the PC clinic, the average total ESAS score had decreased by 11.44 (22%) and all ESAS item scores were improved on average. Conclusions: The cachexia clinic proved a useful means to identify other PC needs and achieve effective PC referrals. We suggest this is proof of concept that specialty clinics can be a meaningful way to achieve an earlier entry point to comprehensive PC in patients who were not previously referred by their Oncologists.

scholarly journals Validation of the Spanish version of the MD Anderson symptom inventory – heart failure (MDASI-HF-Spanish) module

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Anecita Fadol ◽  
Joaquin Buitrago ◽  
Maria C. Diaz ◽  
Valerie Shelton ◽  
Carolyn Harty ◽  
...  
Keyword(s):  
Heart Failure ◽  
Internal Consistency ◽  
Symptom Assessment ◽  
Internal Consistency Reliability ◽  
The United States ◽  
Assessment Instrument ◽  
Symptom Inventory ◽  
Patients With Cancer ◽  
Spanish Speaking ◽  
Md Anderson

Abstract Background The lack of a validated symptom assessment instrument in Spanish for patients with cancer and heart failure (HF) can affect the care and impede the recruitment and participation of Spanish-speaking patients in clinical trials. Spanish is the second most common language spoken by the largest and most rapidly growing racial/ethnic minority group in the United States. To bridge the language barrier and improve symptom management in Spanish-speaking patients with cancer and HF, the MD Anderson Symptom Inventory-Heart Failure (MDASI-HF) was translated to Spanish (MDASI-HF- Spanish). Aim To validate the MDASI-HF-Spanish symptom assessment instrument. Methods Following standard forward and backward translation of the original and previously validated English version of the MDASI-HF, a cognitive debriefing with nine native Spanish speaking participants was conducted to evaluate the participants’ understanding and comprehension of the MDASI-HF-Spanish. To examine the comprehensibility, acceptability and psychometric properties of the translated instrument, the MDASI-HF-Spanish was tested in a convenience sample of 50 Spanish speaking patients with a diagnosis of cancer and HF. Evidence for the psychometric validity of the MDASI-HF-Spanish was demonstrated via its internal consistency reliability and known-group validity. Results Overall, the participants had no problems with the understandability, readability, or number of questions asked. The MDASI-HF-Spanish subscales showed good internal consistency reliability, with a Cronbach’s coefficient alpha of 0.94 (13 core cancer symptoms), 0.92 (8 heart failure symptoms), and 0.90 (6 interference items) respectively. The MDASI-HF-Spanish was able to differentiate the functional status between patients based on the New York Heart Association (NYHA) functional classification. Conclusions The MDASI-HF-Spanish is linguistically and psychometrically valid with ease of completion, relevance, and comprehensibility among the participants, and it can be a useful tool for clinical management and research purposes.

Symptom burden and characteristics of patients who die in the acute palliative care unit of a tertiary cancer center.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 53-53
Author(s):  
YuJung Kim ◽  
Grace S. Ahn ◽  
Hak Ro Kim ◽  
Beodeul Kang ◽  
Sung Soun Hur ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Tertiary Care ◽  
Symptom Burden ◽  
Symptom Assessment ◽  
Assessment System ◽  
Cancer Center ◽  
Advanced Cancer Patients ◽  
Tertiary Cancer Center

53 Background: Acute Palliative Care Units (ACPUs) are novel inpatient programs in tertiary care centers that provide aggressive symptom management and assist transition to hospice. However, patients often die in the APCU before successfully transferring to hospice. The aim of this study was to evaluate the symptom burden and characteristics of advanced cancer patients who die in the APCU. Methods: We retrospectively reviewed the medical records of all advanced cancer patients admitted to the APCU between April, 2015 and March, 2016 at a tertiary cancer center in Korea. Basic characteristics and symptom burden assessed by the Edmonton Symptom Assessment System (ESAS) were obtained from consultation upon APCU admission. Statistical analyses were conducted to compare patients who died in the APCU with those who were discharged alive. Results: Of the 267 patients analyzed, 87 patients (33%) died in the APCU. The median age of patients was 66 (range, 23-97). Patients who died in the APCU had higher ESAS scores of drowsiness (6 vs 5, P = 0.002), dyspnea (4 vs 2, P = 0.001), anorexia (8 vs 6, P = 0.014) and insomnia (6 vs 4, P = 0.001) compared to patients who discharged alive. Total symptom distress scores (SDS) were also significantly higher (47 vs 40, P = 0.001). Patients who died in the APCU were more likely to be male (odds ratio [OR] for female patients 0.38, 95% confidence interval [CI] 0.22-0.67, P < 0.001) and have higher ESAS scores of drowsiness (OR 2.08, 95% CI, 1.08-3.99, P = 0.029) and dyspnea (OR 2.19, 95% CI 1.26-3.80, P = 0.005). These patients showed significantly shorter survival after APCU admission (7 days vs 31 days, P < 0.001). Conclusions: Advanced cancer patients who die in the APCU are more likely to be male and have significantly higher symptom burden that include drowsiness and dyspnea. These patients show rapid clinical deterioration after APCU admission. More proactive and timely end-of-life care is needed for these patients.

scholarly journals Potentially Avoidable Hospital Readmissions in Patients With Advanced Cancer

2019 ◽  
Vol 15 (5) ◽  
pp. e420-e427 ◽  
Author(s):  
P. Connor Johnson ◽  
Yian Xiao ◽  
Risa L. Wong ◽  
Sara D'Arpino ◽  
Samantha M.C. Moran ◽  
...  
Keyword(s):  
Advanced Cancer ◽  
Odds Ratio ◽  
Hospital Readmissions ◽  
Symptom Burden ◽  
Symptom Assessment ◽  
Physical Symptom ◽  
Assessment System ◽  
Primary Reason ◽  
Nonlinear Mixed Effects Models ◽  
Patient Reported

PURPOSE: Patients with cancer often prefer to avoid time in the hospital; however, data are lacking on the prevalence and predictors of potentially avoidable readmissions (PARs) among those with advanced cancer. METHODS: We enrolled patients with advanced cancer from September 2, 2014, to November 21, 2014, who had an unplanned hospitalization and assessed their patient-reported symptom burden (Edmonton Symptom Assessment System) at the time of admission. For 1 year after enrollment, we reviewed patients’ health records to determine the primary reason for every hospital readmission and we classified readmissions as PARs using adapted Graham’s criteria. We examined predictors of PARs using nonlinear mixed-effects models with binomial distribution. RESULTS: We enrolled 200 (86.2%) of 232 patients who were approached. For these 200 patients, we reviewed 277 total hospital readmissions and identified 108 (39.0%) of these as PARs. The most common reasons for PARs were premature discharge from a prior hospitalization (30.6%) and failure of timely follow-up (28.7%). PAR hospitalizations were more likely than non-PAR hospitalizations to experience symptoms as the primary reason for admission (28.7% v 13.0%; P = .001). We found that married patients were less likely to experience PARs (odds ratio, 0.30; 95% CI, 0.15 to 0.57; P < .001) and that those with a higher physical symptom burden were more likely to experience PARs (odds ratio, 1.03; 95% CI, 1.01 to 1.05; P = .012). CONCLUSION: We observed that a substantial proportion of hospital readmissions are potentially avoidable and found that patients’ symptom burdens predict PARs. These findings underscore the need to assess and address the symptom burden of hospitalized patients with advanced cancer in this highly symptomatic population.

scholarly journals Translation and validation of the Chinese version of the MD Anderson Symptom Inventory for measuring perioperative symptom burden in patients with gynecologic cancer

2021 ◽  
Author(s):  
Ting Zhang ◽  
Ying-ying Zheng ◽  
Zhi-rong Yang ◽  
Qiuling Shi ◽  
Xin Shelley Wang ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Symptom Severity ◽  
Assessment Tool ◽  
Gynecologic Cancer ◽  
Symptom Burden ◽  
Chinese Version ◽  
Chinese Patients ◽  
Gynecologic Cancers ◽  
Symptom Inventory ◽  
Md Anderson

Abstract Background: Gynecologic cancers are among the most prevalent malignancies in China, and millions of gynecologic cancer patients are expected to undergo open abdominal surgery as initial treatment. The tumor- and surgery-related symptom burden are not well studied owing to a lack of a standardized and validated assessment tool in Chinese. The study was to translate and validate the MD Anderson Symptom Inventory for measuring perioperative symptom burden in gynecologic cancer patients (MDASI-PeriOp-GYN) and examine the utility of the Chinese version.Methods: The MDASI-PeriOp-GYN was translated in a stepwise manner. First, two native speakers independently translated the 9 PeriOp-GYN symptom items. Then the 9 items were translated back into English by another two bilingual translators. After discussion and revision, the four translators reached an agreement. The finalized Chinese version was administered to women with three common gynecologic cancer types (cervical, ovarian, and endometrial cancers) recruited from the gynecological oncology department of Sichuan Cancer Hospital & Institute between July and October 2019. Reliability and validity of the translated version were assessed. Results: Overall, 324 women with gynecologic cancers were enrolled. Cronbach’s α values were 0.826 and 0.735 for the symptom severity and interference scales, respectively. Test-retest reliability values were 0.885, 0.873, and 0.914 for the symptom severity, PeriOp-GYN, and interference scales, respectively. Significant correlations were found between the MDASI-PeriOp-GYN-C and EORTC QLQ-C30 along with the QLQ-OV28 module (-0.608–0.871, P<0.001). Known-group validity was supported by significant differences in the scores of the four scales grouped by time intervals, surgery type, and functional status (all P<0.01). Conclusions: The MDASI-PeriOp-GYN-C is a valid and reliable tool for measuring symptoms in Chinese patients undergoing surgery for gynecologic cancers. The tool could be used in clinical practice and clinical trials to instantly gather patients’ health and quality of life data.

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