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

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.

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.

Preliminary validation of the Edmonton Symptom Assessment Scale – Acute Leukemia (ESAS-AL) in patients with acute leukemia (AL).

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 210-210
Author(s):  
Columbe Tricou ◽  
Kenneth Mah ◽  
Carmine Malfitano ◽  
Anne Rydall ◽  
Aaron David Schimmer ◽  
...  
Keyword(s):  
Acute Leukemia ◽  
Scale Validation ◽  
Symptom Assessment ◽  
Physical Symptoms ◽  
Assessment Scale ◽  
Preliminary Evaluation ◽  
Preliminary Validation ◽  
Edmonton Symptom Assessment Scale ◽  
Symptom Assessment Scale ◽  
Highly Correlated

210 Background: Patients with AL have numerous symptoms resulting from their disease and its treatment. Here we report on a preliminary evaluation of an ESAS version including AL-specific symptoms (ESAS-AL). Methods: Forty-two inpatients with newly-diagnosed AL (31 AML, 11 ALL), receiving induction chemotherapy, completed baseline assessments with the ESAS-AL and the Memorial Symptom Assessment Scale (MSAS) as part of a clinical trial. The ESAS-AL includes the nine usual ESAS symptoms (rated from 0-10), as well as five symptoms reported by patients with AL in a previous longitudinal study: trouble sleeping, mouth sores, diarrhea, constipation, and itching. Correlations between each ESAS symptom and the corresponding MSAS symptom (rated 1-4) were calculated using Spearman’s correlation. Results: The mean age was 52.86 (SD 15.84). Most correlations were moderate to large and were highly significant (Table). Correlations ranged from 0.86 (ESAS-AL/MSAS Itching) to 0.20 (ESAS-AL Anxiety/MSAS Worried). Correlations for 4 physical symptoms specific to ESAS-AL (itching, diarrhea, mouth sores, and constipation) were among the highest (rs>.70). Correlations between ESAS-AL trouble sleeping and MSAS difficulty sleeping and between ESAS-AL anxiety and MSAS worried were lowest (rs<.30). ESAS-anxiety correlated better with MSAS nervous (rs=.61). Conclusions: Well-defined ESAS-AL physical symptoms are highly correlated with equivalent MSAS symptoms, whereas less well-defined symptoms have weaker correlations. These findings provide preliminary support for the validity of the ESAS-AL. Further data collection for larger-scale validation is ongoing. [Table: see text]

Increased symptom expression among patients (PTS) with delirium admitted to an acute palliative care unit (APCU).

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 56-56
Author(s):  
Maxine Grace De la Cruz ◽  
Sriram Yennu ◽  
Diane D Liu ◽  
Jimin Wu ◽  
Akhila Sunkepally Reddy ◽  
...  
Keyword(s):  
Case Reports ◽  
Symptom Assessment ◽  
Physical Symptoms ◽  
Assessment Scale ◽  
Delirium Assessment ◽  
Wilcoxon Rank Sum Test ◽  
Edmonton Symptom Assessment Scale ◽  
Chi Squared ◽  
Symptom Assessment Scale

56 Background: Previous case reports found that delirium-induced disinhibition may lead to overexpression of symptoms. Our aim was to determine the effect of delirium on the reporting of symptom severity in pts with advanced cancer. Methods: We reviewed 329 consecutive pts admitted to the APCU without a diagnosis of delirium from Jan 2011-Dec 2011. Demographics, Memorial Delirium Assessment Scale (MDAS), ECOG, Edmonton Symptom Assessment Scale (ESAS) on 2 time points were collected. Pts who developed delirium and those who did not develop delirium during the entire course of admission were compared using Chi-Squared test and Wilcoxon rank-sum test. Paired t-test was used to assess if the change of ESAS from baseline to follow-up was associated with delirium. Results: 96/329 (29%) of pts developed delirium during their admission to the APCU. The median time to delirium was 2 days. There was no difference in the length of stay in the APCU for both groups. Table 1 shows the changes in the ESAS scores of the two groups from baseline to follow-up. Pts who did not have delirium expressed improvement in all their symptoms while those who developed delirium during the hospitalization showed no improvement in physical symptoms and worsening in depression, anxiety, appetite and wellbeing. Conclusions: Pts with delirium reported no improvement or worsening symptoms as compared to pts without delirium. Screening for delirium is important in pts who continue to report worsening symptoms despite appropriate management. [Table: see text]

scholarly journals Test-retest reliability of Brazilian version of Memorial Symptom Assessment Scale for assessing symptoms in cancer patients

2017 ◽  
Vol 15 (2) ◽  
pp. 148-154 ◽  
Author(s):  
Josiane Roberta de Menezes ◽  
Bianca Maria Oliveira Luvisaro ◽  
Claudia Fernandes Rodrigues ◽  
Camila Drumond Muzi ◽  
Raphael Mendonça Guimarães
Keyword(s):  
Psychological Symptoms ◽  
Low Frequency ◽  
Weighted Kappa ◽  
Symptom Assessment ◽  
Physical Symptoms ◽  
Assessment Scale ◽  
Retest Reliability ◽  
Memorial Symptom Assessment Scale ◽  
Symptom Assessment Scale ◽  
Test Retest Reliability

ABSTRACT Objective To assess the test-retest reliability of the Memorial Symptom Assessment Scale translated and culturally adapted into Brazilian Portuguese. Methods The scale was applied in an interview format for 190 patients with various cancers type hospitalized in clinical and surgical sectors of the Instituto Nacional de Câncer José de Alencar Gomes da Silva and reapplied in 58 patients. Data from the test-retest were double typed into a Microsoft Excel spreadsheet and analyzed by the weighted Kappa. Results The reliability of the scale was satisfactory in test-retest. The weighted Kappa values obtained for each scale item had to be adequate, the largest item was 0.96 and the lowest was 0.69. The Kappa subscale was also evaluated and values were 0.84 for high frequency physic symptoms, 0.81 for low frequency physical symptoms, 0.81 for psychological symptoms, and 0.78 for Global Distress Index. Conclusion High level of reliability estimated suggests that the process of measurement of Memorial Symptom Assessment Scale aspects was adequate.

Characteristics and outcomes of patients admitted to the acute palliative care unit (APUC) from the emergency center (EC) versus inpatient transfers (IP).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20581-e20581
Author(s):  
SeongHoon Shin ◽  
Eduardo Bruera ◽  
David Hui ◽  
Jung Hye Kwon ◽  
Gary B. Chisholm ◽  
...  
Keyword(s):  
Symptom Burden ◽  
Symptom Assessment ◽  
Rank Test ◽  
Chi Square ◽  
Hematologic Cancer ◽  
C Statistic ◽  
Kaplan Meier ◽  
Edmonton Symptom Assessment Scale ◽  
Chi Square Test ◽  
Symptom Assessment Scale

e20581 Background: Most patients admitted to APCU are transferred from inpatient oncology units. We hypothesized that EC admissions have different symptom burden and outcomes compared to IP patients. In this retrospective cohort study, we compared the symptom burden and survival between the EC and IP groups. Methods: Among all 2,568 patients admitted to our APCU between September 1, 2003 and August 31, 2008, 312 (12%) were EC patients. We randomly selected 298 IP patients as controls. We retrieved the patient demographics, cancer diagnosis, Edmonton Symptom Assessment Scale (ESAS), discharge outcomes, and overall survival from time of admission. Results: EC patients were more like to be black (22% v 11%, p=0.0006) and less likely to have hematologic cancer (5% v 14%, p=0.0003). EC patients had higher pain (5.4 v 4.6, p=0.0004), fatigue (6.7 v 6.1, p=0.0049), nausea (2.7 v 1.6, p<0.0001), insomnia (4.8 v 4.2, p=0.03) and were less likely to be delirious (41% v 55%, p=0.001). EC patients had more public insurance (44% v 38%, p=0.0142), more home discharge (29% v 11%, p=0.0001), longer admission (8 v 7 days, p=0.0002), and were 2.3x as likely to be discharged alive as compared to IP patients (p<0.0001, Wald Chi-square test). Kaplan-Meier plots and log-rank test for survival from admission of APCU for EC and IP groups were not statistically significant (Median survival after admission were 34 v 31 days, p=0.08). In multivariate analysis, EC admission (OR= 1.9, 1.2-3.0), wellbeing (OR=1.12, 1.02-1.23), dyspnea (OR=0.85, 0.79-0.92) and delirium (OR=0.39, 0.24-0.64) were independently significant for being discharge alive. The c-statistic value was 0.71. Conclusions: EC patients have higher acute symptom burden, but more likely to be discharged alive as compared to IP transfer patients. The APCU is successful at managing symptoms and facilitating discharge to the community for EC patients. [Table: see text]

scholarly journals Sexuality and assessment of physical and psychological symptoms of older adults in outpatient care

2021 ◽  
Vol 74 (suppl 2) ◽  
Author(s):  
Natalia Coelho Marques da Silva ◽  
Luana Baldin Storti ◽  
Gabriella Santos Lima ◽  
Renata Karina Reis ◽  
Thaís França de Araújo ◽  
...  
Keyword(s):  
Older Adults ◽  
Sexual Activity ◽  
Psychological Symptoms ◽  
Symptom Assessment ◽  
Well Being ◽  
Sexual Experiences ◽  
Cross Sectional ◽  
Symptom Intensity ◽  
Edmonton Symptom Assessment Scale ◽  
Symptom Assessment Scale

ABSTRACT Objective: to analyze the relationship between affective and sexual experiences and the intensity of physical and psychological symptoms of older adults. Methods: observational, cross-sectional and analytical study, guided by the STROBE tool, carried out in a geriatric outpatient clinic. Sociodemographic and health questionnaire, Affective and Sexual Experiences Scale for Elderly, Edmonton Symptom Assessment Scale were used. Descriptive statistical analysis and Spearman correlation were performed. Results: forty-five older adults participated, with a mean age of 73.8 years; most (91.1%) were married. The highest averages of symptom intensity were pain (4.9), anxiety (4.8), drowsiness (4.5), and a feeling of well-being (4.5). There was a negative correlation between sadness and the dimensions of sexual activity and affective relationships (rs=-0.365; p=0.014 and rs=-0.386; p=0.009) and between anxiety and sexual activity (rs=-0.308; p=0.040). Conclusion: as sadness increases, affective and sexual experiences are less. The greater the anxiety intensity, the lower the sexual experiences.

scholarly journals Symptoms Burden among Women with Gynecological Cancer in Indonesia: A Descriptive Study

2019 ◽  
Author(s):  
Nunung Nurhayati ◽  
Astri Mutiar ◽  
Fitriani Miraz ◽  
Linlin Lindayani ◽  
Dewi Marfuah
Keyword(s):  
Psychological Symptoms ◽  
Gynecological Cancer ◽  
Symptom Burden ◽  
Symptom Assessment ◽  
Common Symptom ◽  
Cross Sectional ◽  
Descriptive Research ◽  
Cancer Nursing ◽  
Symptom Assessment Scale ◽  
Serious Disease

Background: Gynecological cancer is one of the most common reproductive health problems of cancer. Factors that cause high rates of the incidence of gynecological cancer, because many symptoms are ignored so that symptoms that can actually be treated early become a very serious disease. Women with gynecological cancer have a burden of symptoms over time which can cause a negative response to the patient’s physical, psychological and emotional. Objectives: This study aimed to describe the symptom burden in women with gynecological cancer. Methods: This study used quantitative and descriptive research using cross sectional approach. Conducted in May2019,with95subjectsresearchatRumahSinggahinBandungusingconvenience sampling. Symptom Burden was assessed using Memorial Symptom Assessment Scale (MSAS). Resuts: Ten common symptoms experienced by respondents with gynecological cancer were worrying 96.8% (92), feeling sad 95.8% (91), insomnia 93.7% (89), problems with activity or sexual arousal 89, 5% (85), feeling tired 86.3% (82), lack of appetite 81.1% (77), dizziness 80% (76), irritability 80% (76), pain 78.9% (75), less energy 78.9 (75), with a symptom mean of 1.08 (± 0.386). Conclusion: Indicated that psychological symptoms is the common symptom that experienced by women with gynecological cancer. Nursing and other healthcare professional is expected to pay more attention to psychological symptoms to meets the need of patient.    

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

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.

Prevalence and correlates of patient symptom burden at initiation of curative chemotherapy.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 176-176
Author(s):  
Caitlin McCarty ◽  
Lara Traeger ◽  
Joseph A. Greer ◽  
Jennifer S. Temel ◽  
Theresa Margaret McDonnell
Keyword(s):  
Psychological Distress ◽  
Early Stage ◽  
Metastatic Breast ◽  
Symptom Burden ◽  
Symptom Assessment ◽  
Physical Symptom ◽  
Physical Symptoms ◽  
Self Report ◽  
Services Research ◽  
Symptom Bother

176 Background: Side effects of curative chemotherapy regimens are highly prevalent and can lead to unplanned oncology clinic visits or hospital-level care. The current study aim was to examine physical symptoms among patients at their first chemotherapy visit, even prior to receiving their first infusion, in order to characterize symptom burden and unmet needs at this early stage of care. Methods: The current study utilized baseline data from a larger health services research trial for consecutive patients initiating chemotherapy for non-metastatic breast (48.0%), colorectal (28.0%), or lung (24.0%) cancer (n=75). Patients were invited to complete a self-report survey at their first chemotherapy visit, including demographics and measures of physical symptoms (Memorial Symptom Assessment Scale) and psychological distress (Patient Health Questionnaire-4; score ≥ 3 indicates positive anxiety or depression screen). Results: Among participants (M age=55.3 [SD=13.3]; female=70.7%), more than half (54.7%) endorsed at least one physical symptom -- primarily fatigue (34.7%) and constipation (29.3%). Additionally, one-fourth (25.3%) screened positive for anxiety (22.7%) and/or depression (9.3%). There were no differences in physical symptom bother or likelihood of fatigue or constipation, by factors including patient age, gender, marital status, work status, disease type, recent surgery, or concurrent radiotherapy. However, patients with positive anxiety and/or depression screens reported greater symptom bother and were more likely to endorse fatigue relative to those with negative screens (Mbother=4.5 vs. 1.3; fatigue=78.9% vs. 19.6%, p’s<.01). There was no difference in constipation between these groups. Conclusions: Symptom frequency was markedly high among patients initiating curative chemotherapy, with at least half reporting physical symptoms prior to their first infusion, and psychological distress clustered with general symptom bother and fatigue. Future work should explore 1) the extent to which physical and psychological symptoms at chemotherapy initiation may be associated with longitudinal symptom profiles, and 2) strategies for addressing symptom burden early on in outpatient care.

Symptom burden in hospitalized patients with curable and incurable cancers.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 190-190
Author(s):  
Lauren Waldman ◽  
Richard Newcomb ◽  
Ryan David Nipp ◽  
Ephraim P. Hochberg ◽  
Vicki Jackson ◽  
...  
Keyword(s):  
Palliative Care ◽  
Psychological Distress ◽  
Supportive Care ◽  
Psychological Symptoms ◽  
Symptom Burden ◽  
Symptom Assessment ◽  
Physical Symptoms ◽  
Hospitalized Patients ◽  
Assessment System ◽  
Care Utilization

190 Background: Inpatient supportive care interventions are targeted to patients with advanced solid tumors due to perceived higher symptom burden. Yet, few studies have characterized symptom prevalence in hospitalized patients with curable cancers. We aimed to describe and compare symptom burden and palliative care utilization in hospitalized patients with curable and incurable cancers to determine the allocation of such supportive care resources. Methods: We conducted a single center study of 1549 patients (238 curable hematologic, 239 curable solid, 123 incurable hematologic, 949 incurable solid cancers) who experienced an unplanned hospitalization between 9/14 - 4/17. On admission, we assessed patients’ physical symptoms (Edmonton Symptom Assessment System) and psychological distress (Patient Health Questionnaire - 4 and Primary Care PTSD Screen). Results: The median number of moderate to severe symptoms reported by patients with curable hematologic, curable solid, incurable hematologic, and incurable solid cancers were 5 [3-6], 5 [3-7], 5 [4-6], and 6 [4-7], respectively. Most patients reported moderate to severe fatigue (83.6%, 82.9%, 81.3%, 86.9%). Table 1 depicts rates of psychological distress. In adjusted analyses patients with incurable solid cancers reported higher symptom burden (β = 7.6, p < 0.01), depression (β = 0.4, p = 0.01), and anxiety (β = 0.3, p = 0.03) symptoms, but no difference in PTSD symptoms. Among patients in top quartile of symptom burden, palliative care was consulted in 16.2%, 7.9%, 23.8%, and 49.6% (p < 0.01) of patients with curable hematologic, curable solid, incurable hematologic, and incurable solid cancers, respectively. Conclusions: Hospitalized patients with solid and hematologic cancers experience substantial physical and psychological symptoms regardless of the curability of their illness. Palliative care is rarely consulted for highly symptomatic patients with curable cancers. Inpatient supportive care interventions should target the needs of all highly symptomatic patients with cancer. [Table: see text]

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