Self-reported overall wellbeing (OWb), physical function (PFn), and PRO-CTCAE symptom scores in post-operative and chemotherapy patients.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 2064-2064
Author(s):  
Hannah Hazard ◽  
Raymond U. Osarogiagbon ◽  
Sandra L. Wong ◽  
Jessica J Bian ◽  
Don S. Dizon ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Severe Symptom ◽  
Symptom Burden ◽  
Well Being ◽  
Patient Portal ◽  
Moderate Correlation ◽  
Single Item ◽  
Response Options ◽  
Symptom Scores ◽  
Chemotherapy Patients

2064 Background: A standardized, validated tool for capturing symptoms from cancer patients, PRO-CTCAE, has been used to reduce symptom burden, decrease acute care needs, and preserve quality of life. The association between specific PRO-CTCAE symptom scores and single item measures of OWb and PFn were characterized to understand symptom constellations. Methods: A novel Epic-based symptom management program (eSyM) was deployed for GI, GYN, and thoracic cancer patients starting chemotherapy (Memphis Baptist) or having surgery (WVU Medicine). Patients received automated prompts to complete surveys via the patient portal (MyChart) on a fixed schedule, approximately twice/week. Each survey included one OWb item, one PFn item, and at least 6 PRO-CTCAE items (pain, nausea, vomiting, fatigue, anxiety, insomnia). The OWb and PFn items, which were created de novo, included 5 ordinal response options with corresponding pictograms (emojis from very happy to very sad for OWb; a figure walking to one prone in bed for PFn). Composite scores were generated: 0 for no symptoms, 1-2 for mild/moderate symptoms, and 3 for severe symptoms. We describe OWb and PFn and analyze associations between these items and PRO-CTCAE symptom scores. Results: Between 9/10/19-1/22/20, we collected 908 eSyM responses from 166 chemotherapy patients at Baptist (Age, M = 65), and 480 eSyM responses from 97 postoperative patients at WVU (Age, M = 57). The OWb and PFn scores demonstrated moderate correlation with PRO-CTCAE symptom scores (Baptist r = 0.63; WVU r = 0.75), and moderate correlation with mean symptom scores among surgery patients at WVU (r = 0.74); but lower correlation among chemotherapy patients at Baptist (r = 0.53-0.55). Scores improved over time following surgery, but not after initiation of chemotherapy. Among the 730 eSyM responses with none/mild values for both OWb and PFn (52.9% of all responses), only 4.5% reported any severe symptom; among 651 responses with impairment of OWb and/or PFn, 45.2% reported at least one severe symptom. Conclusions: Integration of eSyM into the Epic EHR enabled tracking of OWb, PFn, and PRO-CTCAE items. When asked alongside PRO-CTCAE symptom items, two single item OWb and PFn measures provided distinct information and correlated with symptom burden. These results demonstrate the feasibility of integrating ePRO collection into routine post-operative and medical oncology care and that PRO-CTCAE items provide information that is distinct from that obtained from global metrics of well-being. Clinical trial information: NCT03850912.

Performance Status and Symptom Scores of Women With Gynecologic Cancer at the End of Life

2013 ◽  
Vol 23 (5) ◽  
pp. 971-978 ◽  
Author(s):  
Lori Spoozak ◽  
Hsien Seow ◽  
Ying Liu ◽  
Jason Wright ◽  
Lisa Barbera
Keyword(s):  
Cervical Cancer ◽  
End Of Life ◽  
Performance Status ◽  
Gynecologic Cancer ◽  
Symptom Burden ◽  
Symptom Assessment ◽  
Well Being ◽  
Assessment System ◽  
Edmonton Symptom Assessment System ◽  
Symptom Scores

ObjectiveThe Palliative Performance Scale (PPS), which measures performance status (100 = best performance to 0 = dead), and the Edmonton Symptom Assessment System (ESAS), which measures severity of 9 symptoms, are routinely collected at ambulatory cancer visits in Ontario. This study describes the trajectory of scores in patients with gynecologic cancer in the last 6 months of life.MethodsAn observational study was conducted between 2007 and 2010. Patients had ovarian/fallopian tube, uterine, and cervical cancer and required 1 or more PPS or ESAS assessment in the 6 months before death. Outcomes were the average PPS and ESAS scores per week before death. Using logistic regression, we analyzed the odds ratio of reporting a moderate to severe score for each symptom.ResultsSeven hundred ninety-five (PPS) and 1299 (ESAS) patients were included. The average PPS score started at 70 and ended at 30, rapidly declining in the last 2 months. For ESAS symptoms, drowsiness, decreased well-being, lack of appetite, and tiredness increased in severity closer to death and were prevalent in more than 70% of patients in the last week of life. Patients with cervical cancer had increased odds of moderate to severe pain (1.74; 95% confidence interval, 1.30–2.32) compared with ovarian cancer.ConclusionsTrajectories of mean performance status had not reached the “end-of-life” phase until 1 week before death. A large proportion of the gynecologic cancer patients reported moderate to severe symptom scores as death approached. Pain was uniquely elevated in the cervical cancer cohort as death approached. Adequately managing the symptom burden appears to be a significant issue in end-of-life gynecologic care.

scholarly journals Consideration of Symptom Burden Based Treatment in PV and ET Patients: An Analysis By MPN International Quality of Life Study Group

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5463-5463
Author(s):  
Robyn M. Scherber ◽  
Holly Geyer ◽  
Heidi E. Kosiorek ◽  
Amylou C. Dueck ◽  
Jean-Jacques Kiladjian ◽  
...  
Keyword(s):  
Board Of Directors ◽  
Symptom Score ◽  
Research Funding ◽  
Severe Symptom ◽  
Symptom Burden ◽  
Prior History ◽  
Scoring Method ◽  
Advisory Committees ◽  
Single Item ◽  
Night Sweats

Abstract BACKGROUND: Symptom burden in essential thrombocythemia (ET) and polycythemia vera (PV) is severe even among individuals with low risk disease (Blood 2012. 12;123(24):3803-10). New therapies exist which alleviate the severe symptom burden and reduce splenomegaly in ET and PV patients (N Engl J Med 2015; 372:426-435). This analysis is the first to date to evaluate thresholds at which symptom-based treatment can be considered for ET and PV patients who are intolerant or resistant to hydroxyurea (HU). METHODS: Patient demographics, symptom burden, and disease traits were collected from ET and PV patients at a single time point during therapy. The MPN-10 total symptom score (TSS, JCO 2012;30(33)4098-103) was utilized to assess symptom burden. Symptom criteria models were determined as previously described among a population of MF patients (Scherber et. al. EHA 2016: a2250). Cutoffs were then evaluated in a cohort of ET and PV patients to assess for utility as a symptom model among this population. RESULTS: Demographics and symptom burden: 838 PV and 867 ET patients with previous hydroxyurea therapy were included in this analysis. Patients were of mean age (54.9 years ET, 64.0 years PV) and gender (69.2% female ET, 55.7% female). Mean disease duration was 6.0 years for ET and 7.3 years for PV.Among ET and PV patients, 15.0% and 24.2% had prior thrombosis respectively. In evaluating prognostic risk, ET patients tended to be low (45.5%) or intermediate risk (42.9%) with only a minority of patient meeting criteria forhigh risk disease (11.6%). Laboratory findings: ET patients had a mean platelet value of 598.7x 109/L(SD=283.4). Among PV patients, mean hematocrit was 45.8% (SD=8.1) and 42.6% of patients had a hematocrit of greater than 45%. White blood cell count was normal between the two groups (ET mean 8.3 x 109/L, PV mean 9.0 x 109/L). Symptoms: Mean worst symptom severity was 6.4 out of 10 (SD=2.7). Among ET patients, worst symptom was most frequently fatigue (32.7%, mean 5.0/10, SD=3.1, overall prevalence 88%) followed by night sweats (13.6%, mean 2.0/10, SD=3.0, overall prevalence 53%) and concentration difficulties (8.6%, mean 3.1/10, SD=3.0, overall prevalence 68%). For PV, worst individual symptom items were most frequently fatigue (29.2%, mean 5.2/10, SD=3.0, overall prevalence 91%), pruritus (14.1%, mean 3.2/10, SD=3.2, overall prevalence 69%), and night sweats (12.8%, mean 2.5/10, SD=3.0, overall prevalence 57%). Cutoff Scoring: 47.0% of ET patients fit criteria for TSSgreater than to equal to 20; 59.0%% had a single itemgreater than 5; and 45.7% had both a TSS greater than or equal to 20 and a single item greater than 5. Among PV participants, 54.5% had aTSS greater than to equal to 20; 66.1% had a single itemgreater than 5; and 51.5% had both a TSS greater than or equal to 20 and a single item greater than 5. Each scoring method was significantly associated with individual item scores (Table 1). Prognostic scoring was not significantly associated with any of the symptom cutoffs evaluated. Correlations: Among ET patients, a prior history of thrombosis was significantly associated with having a worst symptom item greater than 5 (p=0.043). ET patients with lower hemoglobin were significantly more likely to meet criteria for a MPN-10 score greater than or equal to 20 or to meet combined criteria for a MPN-10 greater than or equal to 20 and single worst item greater than 5 (for both p=0.01 or less). For PV, lower hematocrit levels were significantly associated with having an individual worst symptom score of greater than 5 (44.9% versus 46.7%, p=0.0376). CONCLUSION: Assessment of ET and PV symptoms, now measurable through standardized and practical instruments such as the MPN-10, is an integral part of determining therapeutic impact of newer therapies in both clinical practice and trial settings. In our modeling, patients with severe symptom burden profiles are well represented by utilizing cutoff criteria including aworst individual symptom item of greater than 5 out of 10, an MPN-10 score of greater than or equal to 20, or combined criteria of both cutoffs. These cutoffs can be considered when determiningwhich HU intolerant or resistant patients would most benefit fromsymptom orientedtreatment. Disclosures Kiladjian: AOP Orphan: Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Honoraria, Research Funding. Schouten:Novartis: Consultancy; Sanofi: Consultancy. Etienne:BMS: Speakers Bureau; ARIAD: Speakers Bureau; Pfizer: Speakers Bureau; novartis: Consultancy, Speakers Bureau. Harrison:Incyte Corporation: Honoraria, Speakers Bureau; Shire: Honoraria, Speakers Bureau; Gilead: Honoraria, Speakers Bureau; Baxaltra: Consultancy, Honoraria, Speakers Bureau; Novartis: Consultancy, Honoraria, Other: travel, accommodations, expenses, Research Funding, Speakers Bureau. Radia:Pfizer: Honoraria; Novartis: Honoraria. Cervantes:AOP Orphan: Membership on an entity's Board of Directors or advisory committees; Baxalta: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Novartis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Vannucchi:Novartis: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau. Mesa:Promedior: Research Funding; Celgene: Research Funding; CTI: Research Funding; Gilead: Research Funding; Incyte: Research Funding; Galena: Consultancy; Ariad: Consultancy; Novartis: Consultancy.

Machine learning to classify clinically meaningful patient groups by ESAS symptom clusters in oropharyngeal cancer patients undergoing initial treatment.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 171-171
Author(s):  
Ghazal Haddad ◽  
Katrina Hueniken ◽  
Scott Victor Bratman ◽  
John R de Almeida ◽  
David Paul Goldstein ◽  
...  
Keyword(s):  
Machine Learning ◽  
Cancer Patients ◽  
Statistical Methods ◽  
Oropharyngeal Cancer ◽  
Initial Treatment ◽  
Symptom Burden ◽  
Symptom Clusters ◽  
Assessment System ◽  
Symptom Scores ◽  
Patient Groups

171 Background: Cancer patients often experience symptoms in clusters, which could contribute to patient outcomes and quality of life; yet most analyses describe only individual symptom scores or a summation of symptom scores rather than symptom clusters. We compared machine learning to traditional statistical methods for grouping patients by symptoms in a heavy symptom burden patient population: oropharyngeal cancer patients undergoing initial treatment with radiation or chemoradiation (C/RT). Methods: K-means clustering was compared to traditional statistical methods (i.e., histogram-analysis; use of quantiles; categorization by clinico-demographic features) for classifying patients based on Edmonton Symptom Assessment System (ESAS) symptom scores in newly diagnosed oropharyngeal cancer patients before and after C/RT initiation. Results: 278 patients were classified into 3 K-means groups at each of two timepoints: pre-C/RT and post-C/RT. These groupings were formed primarily based on differences by symptom burden and were thus labeled: low, moderate, and high symptom-burden patient groups. The table shows dynamic change as patients moved from group to group during C/RT treatment. Greatest symptom-burdens in pre-C/RT patients were anxiety and tiredness; in post-C/RT, poor appetite and tiredness. Chi-squared residuals attributed being female (residuals of -3.95 for low, -2.46 for moderate, and 2.41 for high burden) and HPV-negative cancer (residuals of -1.48, -0.52, and 2.57, respectively) to being associated with higher symptom burden pre-C/RT; no clinico-demographic characteristics were associated with high symptom burden post-C/RT, suggesting this was a previously unidentified patient group. Although separation into K-means clusters in this population was primarily related to symptom burden, K-means better identified the number of patient groups and classified patients at the boundaries between groups (involving up to a quarter of patients) when compared to traditional statistical methods. Conclusions: Machine learning clustering analysis separated patients into discrete groups by symptom burden. K-means provided an objective means for clustering patients in a clinically-meaningful way when compared to traditional statistical methods for grouping patients. [Table: see text]

Do patient-reported symptoms predict for emergency department visits? A population-based analysis.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 6039-6039
Author(s):  
Lisa Catherine Barbera ◽  
Clare Atzema ◽  
Rinku Sutradhar ◽  
Hsien Seow ◽  
Doris Howell ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cancer Patients ◽  
Symptom Assessment ◽  
Well Being ◽  
Population Based ◽  
Emergency Department Visits ◽  
Assessment System ◽  
Patient Reported ◽  
Symptom Scores ◽  
Ed Visits

6039 Background: Since 2007 in Ontario, Canada, the Edmonton Symptom Assessment System (ESAS) has been routinely used to assess symptoms in cancer patients in both ambulatory and home-care settings. The purpose of this study was to determine the relationship between individual patient symptoms, and their severity, with the likelihood of an emergency department (ED) visit. Methods: The cohort includes all cancer patients in Ontario who completed an ESAS assessment between January 2007 and March 2009. We linked multiple provincial health databases to describe the cohort and determine if an ED visit occurred within 7 days of the patient’s first ESAS. Multivariate logistic regression was used to determine the association between symptom scores (absent: score 0; mild: 1-3; moderate: 4-7; severe: 8-10) and the likelihood of an ED visit. Results: The cohort included 45,118 unique patients whose first assessment contributes to the study. 3.8% (n=1732) had an ED visit. The patients with ED visits were more likely to be men, to have lung or gastro-intestinal cancer, to have had recent radio or chemotherapy, and to have a shorter survival. The proportion of patients with ED visits increased from 2% to 10-12% as individual symptom scores increased from 0 to 10. Anxiety and depression were not associated with ED visits in the model, regardless of severity. Pain, nausea, drowsiness, appetite and shortness of breath with moderate or severe scores were associated with ED visits. Tiredness and wellbeing were the only symptoms to show a significant association for mild, moderate and severe scores. A well being score of 7-10 (reference score=0) had the highest odds ratio of 1.8 (95% CI 1.4-2.3). Conclusions: Worsening symptoms clearly contribute to ED visits. While specific symptoms like pain are obvious targets for management in the outpatient setting, constitutional symptoms like wellbeing or fatigue are associated with even higher odds. Though difficult to manage, such symptoms also warrant detailed assessment in order to optimize patient outcomes.

Patient-reported symptoms following diagnosis in esophagus cancer patients treated with palliative intent

2020 ◽  
Vol 33 (8) ◽  
Author(s):  
Laura E Davis ◽  
Vaibhav Gupta ◽  
Catherine Allen-Ayodabo ◽  
Haoyu Zhao ◽  
Julie Hallet ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Cancer Patients ◽  
Psychosocial Support ◽  
Symptom Burden ◽  
Well Being ◽  
Assessment System ◽  
Esophagus Cancer ◽  
Early Palliative Care ◽  
Treatment Type ◽  
Patient Reported

Summary The majority of patients with esophagus cancer have advanced-stage disease without curative options. For these patients, treatment is focused on improving symptoms and quality of life. Despite this, little work has been done to quantify symptom burden for incurable patients. We describe symptoms using the Edmonton Symptom Assessment System (ESAS) among esophagus cancer patients treated for incurable disease. This retrospective cohort study linked administrative datasets to prospectively collected ESAS data of non-curatively treated adult esophagus cancer patients diagnosed between January 1, 2009 and September 30, 2016. ESAS measures nine common cancer-related symptoms: anxiety, depression, drowsiness, lack of appetite, nausea, pain, shortness of breath, tiredness, and impaired well-being. Frequency of severe symptoms (score ≥ 7/10) was described by month for the 6 months from diagnosis for all patients and by treatment type (chemotherapy alone, radiotherapy alone, both chemotherapy and radiotherapy, and best supportive care). A sensitivity analysis limited to patients who survived at least 6 months was performed to assess robustness of the results to proximity to death and resulting variation in follow-up time. Among 2,989 esophagus cancer patients diagnosed during the study period and meeting inclusion criteria, 2,103 reported at least one ESAS assessment in the 6 months following diagnosis and comprised the final cohort. Patients reported a median of three (IQR 2–7) ESAS assessments in the study period. Median survival was 7.6 (IQR 4.1–13.7) months. Severe lack of appetite (53.1%), tiredness (51.1%), and impaired well-being (42.7%) were the most commonly reported symptoms. Severe symptoms persisted throughout the 6 months after the diagnosis. Subgroup analysis by treatment showed no worsening of symptoms over time in those treated by either chemotherapy alone, or both chemotherapy and radiation. Results followed a similar pattern on sensitivity analysis. Patients diagnosed with incurable esophagus cancer experience considerable symptom burden in the first 6 months after diagnosis and the frequency of severe symptoms remains high throughout this period. Patients with this disease require early palliative care and psychosocial support upon diagnosis and support throughout the course of their cancer journey.

Meaning-Centered Group Psychotherapy for Advanced Cancer Patients

2017 ◽  
Author(s):  
William Breitbart ◽  
Allison J. Applebaum ◽  
Melissa Masterson
Keyword(s):  
Cancer Patients ◽  
Group Psychotherapy ◽  
Advanced Cancer ◽  
Symptom Burden ◽  
Well Being ◽  
Evidence Base ◽  
Advanced Cancer Patients ◽  
Spiritual Well Being ◽  
Desire For Death ◽  
Anxiety Depression

The ability to sustain a sense of meaning is significantly associated with important elements of end-of-life despair. Meaning-centered group psychotherapy (MCGP), an eight-session group psychotherapy intervention, was developed to help patients with advanced cancer sustain or enhance a sense of meaning. MCGP has been shown to significantly improve spiritual well-being, sense of meaning, and quality of life and to diminish anxiety, depression, hopelessness, symptom burden distress, and desire for death. The mechanism of this benefit is through the enhancement of meaning. MCGP appears to be a beneficial intervention for emotional and spiritual suffering in advanced cancer patients. This chapter describes the theoretical framework and research basis for pursuing an intervention to enhance or sustain meaning. It also describes the development of MCGP, its evidence base for clinical efficacy, and outlines the intervention in great detail.

Symptom Burden in the First Year After Cancer Diagnosis: An Analysis of Patient-Reported Outcomes

2018 ◽  
Vol 36 (11) ◽  
pp. 1103-1111 ◽  
Author(s):  
Lev D. Bubis ◽  
Laura Davis ◽  
Alyson Mahar ◽  
Lisa Barbera ◽  
Qing Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Supportive Care ◽  
Patient Reported Outcomes ◽  
Severe Symptom ◽  
Symptom Burden ◽  
Cancer Site ◽  
First Year ◽  
Patients With Cancer ◽  
Patient Reported ◽  
Symptom Scores

Purpose Improvement in the quality of life of patients with cancer requires attention to symptom burden across the continuum of care, with the use of patient-reported outcomes key to achieving optimal care. Yet there have been few studies that have examined symptoms in the early postdiagnosis period during which suboptimal symptom control may be common. A comprehensive analysis of temporal trends and risk factors for symptom burden in newly diagnosed patients with cancer is essential to guide supportive care strategies. Methods A retrospective observational study was performed of patients who were diagnosed with cancer between January 2007 and December 2014 and who survived at least 1 year. Patient-reported Edmonton Symptom Assessment System scores, which are prospectively collected at outpatient visits, were linked to provincial administrative health care data. We described the proportion of patients who reported moderate-to-severe symptom scores by month during the first year after diagnosis according to disease site. Multivariable logistic regression models were constructed to identify risk factors for moderate-to-severe symptom scores. Results Of 120,745 patients, 729,861 symptom assessments were recorded within 12 months of diagnosis. For most symptoms, odds of elevated scores were highest in the first month, whereas nausea had increased odds of elevated scores up to 6 months after diagnosis. On multivariable analysis, cancer site, younger age, higher comorbidity, female sex, lower income, and urban residence were associated with significantly higher odds of elevated symptom burden. Conclusion A high prevalence of moderate-to-severe symptom scores was observed in cancers of all sites. Patients are at risk of experiencing multiple symptoms in the immediate postdiagnosis period, which underscores the need to address supportive care requirements early in the cancer journey. Patient subgroups who are at higher risk of experiencing moderate-to-severe symptoms should be targeted for tailored supportive care interventions.

scholarly journals Impact of Palliative Care in Evaluating and Relieving Symptoms in Patients with Advanced Cancer. Results from the DEMETRA Study

2020 ◽  
Vol 17 (22) ◽  
pp. 8429
Author(s):  
Oscar Corli ◽  
Giacomo Pellegrini ◽  
Cristina Bosetti ◽  
Luca Riva ◽  
Matteo Crippa ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Symptom Burden ◽  
Symptom Assessment ◽  
Well Being ◽  
Physical Symptoms ◽  
Assessment System ◽  
Intervention Patient ◽  
Almost All

Background: Cancer patients experience multiple symptoms throughout the course of the disease. We aimed to provide a comprehensive analysis of the symptom burden in patients with advanced cancer at admission to specialist palliative care (PC) services and seven days later to estimate the immediate impact of PC intervention. Patient and methods: The analysis was based on an observational, prospective, multicenter study (named DEMETRA) conducted in Italy on new patients accessing network specialist PC centers during the period May 2017–November 2017. The prevalence and intensity of symptoms were assessed at baseline and after seven days using three tools including the Edmonton Symptom Assessment System (ESAS). Results: Five PC centers recruited 865 cancer patients. Thirty-three different symptoms were observed at the baseline, the most frequent being asthenia (84.9%) and poor well-being (71%). The intensity of the most frequent symptoms according to ESAS ranged from 5.5 for asthenia to 3.9 for nausea. The presence and intensity of physical symptoms increased with increasing levels of anxiety and depression. After seven days, prevalence of nausea and breathlessness as well as intensity of almost all symptoms significantly decreased. Conclusions: The study confirmed the considerable symptom burden of patients with advanced cancer. PC intervention has significantly reduced the severity of symptoms, despite the patients’ advanced disease and short survival.

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.

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