Predicting acute care use following the initiation of systemic therapy for solid tumors.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 6-6
Author(s):  
Robert C Grant ◽  
Rahim Moineddin ◽  
Zhan Yao ◽  
Melanie Lynn Powis ◽  
Ruth Croxford ◽  
...  
Keyword(s):  
Solid Tumors ◽  
Acute Care ◽  
Systemic Therapy ◽  
Validation Cohort ◽  
Systemic Treatment ◽  
Symptom Assessment ◽  
Calibration Table ◽  
C Statistic ◽  
Edmonton Symptom Assessment Scale ◽  
Symptom Assessment Scale

6 Background: Emergency department (ED) visits and hospitalizations are undesirable and costly. We developed and validated the PROACCT (PRediction Of Acute Care use during Cancer Treatment) score to predict at least one acute care visit during the first 30 days (AC30) after initiating systemic therapy for cancer. Methods: Using administrative data, we identified patients in Ontario with the 18 most common solid tumors who started systemic treatment from July 1, 2014 to June 30, 2015. Southwestern and Northeastern Ontario formed the development and validation cohorts, respectively. We created a score to predict AC30 using multivariate logistic regression in the development cohort. Combinations of tumor sites and regimens were grouped into quintiles based on AC30. The score was assessed in the validation cohort. Results: AC30 occurred in 23% (4438/19359) of patients. Eleven factors predicted AC30 and formed the score: tumor site and regimen (2nd quintile: 2; 3rd-4th: 3; 5th: 4), recent ED visit (2), recent palliative radiation (1), rural residence (1) and Edmonton Symptom Assessment Scale anxiety (4+: 1), lack of appetite (4+: 1), pain (4+: 1), and wellbeing (4+: 1). Among the 204 tumor-regimen combinations, tumors with poor prognoses, such as pancreatic and lung, and platinum- and taxane-containing regimens, carried the highest risk for AC30. The score had moderate discrimination (c-statistic 0.65; P< 0.001) and strong calibration (Table) in the validation cohort. Conclusions: PROACCT identifies factors that predict AC30 in patients starting systemic treatment for solid tumors and could be incorporated into electronic health records to select patients for preventative interventions. [Table: see text]

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]

Development and Validation of a Modified Version of the Edmonton Symptom Assessment Scale in a Flemish Palliative Care Population

2011 ◽  
Vol 28 (7) ◽  
pp. 475-482 ◽  
Author(s):  
Patricia Claessens ◽  
Johan Menten ◽  
Paul Schotsmans ◽  
Bert Broeckaert
Keyword(s):  
Palliative Care ◽  
Symptom Assessment ◽  
Assessment Scale ◽  
Face Validity ◽  
Patients With Cancer ◽  
Edmonton Symptom Assessment Scale ◽  
The Face ◽  
Palliative Care Units ◽  
Symptom Assessment Scale ◽  
Development And Validation

Palliative cancer patients are faced with multiple symptoms that threaten their quality of life. To manage these symptoms, a reliable and valid way of registration is crucial. In this study, the Edmonton Symptom Assessment Scale (ESAS) has been translated, modified, and tested on content, face, criterion, construct validity, and internal consistency for patients admitted to Flemish palliative care units. These aspects are tested in a descriptive, comparative, longitudinal study based on 3 convenience samples. The first consisted of 8 palliative care experts. The second sample checked the face validity and consisted of 4 patients, 5 family members, and 5 nurses. The last sample involved 23 patients admitted to 3 Flemish palliative care units. Heedful of the “new-wave” vision on validity, the translated and altered ESAS seemed a suitable instrument for the symptom assessment of patients with cancer admitted to a palliative care unit.

Symptom Management in Palliative Medicine

2012 ◽  
Author(s):  
Kathy J Selvaggi ◽  
Janet L Abrahm
Keyword(s):  
Symptom Management ◽  
Symptom Control ◽  
Hot Flashes ◽  
Symptom Assessment ◽  
Symptomatic Treatment ◽  
Assessment Scale ◽  
Transdermal Fentanyl ◽  
Memorial Symptom Assessment Scale ◽  
Edmonton Symptom Assessment Scale ◽  
Symptom Assessment Scale

Palliative care is an interdisciplinary specialty focused on providing comfort, communication, and support for patients, families, and professional caregivers throughout the course of a life-limiting illness. This chapter discusses assessment and treatment of symptoms and disorders that commonly contribute to patient distress during these illnesses: pain, disorders of the respiratory and gastrointestinal systems, skin disorders, hot flashes, fatigue, pruritis, insomnia, and delirium. This chapter reviews care of the imminently dying patient, discusses methods for assessing patients' symptoms, and provides two examples of valid and reliable symptom measurement systems: the Edmonton Symptom Assessment Scale and the Memorial Symptom Assessment Scale. Achieving symptom control requires the physician to assess patient suffering in all dimensions: physical, psychological, social, and spiritual. The extent of the assessment may be modified, however, based on patients’ prognosis as well as their goals and the burden and benefit of the diagnostic intervention. A 10-step protocol for terminal wean is presented. Signs that patients are entering their final days and symptom management in the last hours of a patient's life are discussed. Tables list the modified Edmonton Symptom Assessment Scale; the Memorial Symptom Assessment Scale; the DOLOPLUS-2 scale (behavioral pain assessment in the elderly); relative potencies of commonly used opioids; conversions between the transdermal fentanyl patch and morphine; symptomatic treatment for dyspnea, cough, and hiccups; pharmacologic treatment of nausea and vomiting; a progressive bowel regimen for patients receiving opioid therapy; treatments for constipation; etiology-based treatment for oral problems; risk factors for pressure ulcers; and applicable medications for physical and psychological sources of distress near the end of life. This review contains 12 tables and 120 references

scholarly journals Patterns of Opioid Prescription, Use, and Costs Among Patients With Advanced Cancer and Inpatient Palliative Care Between 2008 and 2014

2019 ◽  
Vol 15 (1) ◽  
pp. e74-e83 ◽  
Author(s):  
Sriram Yennurajalingam ◽  
Zhanni Lu ◽  
Suresh K. Reddy ◽  
EdenMae C. Rodriguez ◽  
Kristy Nguyen ◽  
...  
Keyword(s):  
Palliative Care ◽  
Advanced Cancer ◽  
Symptom Assessment ◽  
Patient Characteristics ◽  
Opioid Prescription ◽  
Patients With Cancer ◽  
Edmonton Symptom Assessment Scale ◽  
Symptom Assessment Scale ◽  
Symptom Changes

PURPOSE: An understanding of opioid prescription and cost patterns is important to optimize pain management for patients with advanced cancer. This study aimed to determine opioid prescription and cost patterns and to identify opioid prescription predictors in patients with advanced cancer who received inpatient palliative care (IPC). MATERIALS AND METHODS: We reviewed data from 807 consecutive patients with cancer who received IPC in each October from 2008 through 2014. Patient characteristics; opioid types; morphine equivalent daily dose (MEDD) in milligrams per day of scheduled opioids before, during, and after hospitalization; and in-admission opioid cost per patient were assessed. We determined symptom changes between baseline and follow-up palliative care visits and the in-admission opioid prescription predictors. RESULTS: A total of 714 (88%) of the 807 patients were evaluable. The median MEDD per patient decreased from 150 mg/d in 2008 to 83 mg/d in 2014 ( P < .001). The median opioid cost per patient decreased and then increased from $22.97 to $40.35 over the 7 years ( P = .03). The median MEDDs increased from IPC to discharge by 67% ( P < .001). The median Edmonton Symptom Assessment Scale pain improvement at follow-up was 1 ( P < .001). Younger patients with advanced cancer (odds ratio [OR[, 0.95; P < . 001) were prescribed higher preadmission MEDDs (OR, 1.01; P < .001) more often in the earlier study years (2014 v 2009: OR, 0.18 [ P = .004] v 0.30 [ P = .02]) and tended to use high MEDDs (> 75 mg/d) during hospitalization. CONCLUSION: The MEDD per person decreased from 2008 to 2014. The opioid cost per patient decreased from 2008 to 2011 and then increased from 2012 to 2014. Age, prescription year, and preadmission opioid doses were significantly associated with opioid doses prescribed to patients with advanced cancer who received IPC.

scholarly journals Validation of the Edmonton Symptom Assessment Scale

Cancer ◽  
2000 ◽  
Vol 88 (9) ◽  
pp. 2164-2171 ◽  
Author(s):  
Victor T. Chang ◽  
Shirley S. Hwang ◽  
Martin Feuerman
Keyword(s):  
Symptom Assessment ◽  
Assessment Scale ◽  
Edmonton Symptom Assessment Scale ◽  
Symptom Assessment Scale

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]

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