Predictors of symptom severity and response in patients with metastatic cancer.
We examined determinants of symptom severity and response to treatment among 150 patients with cancer participating in a phase II trial of a palliative care team intervention. Patients completed a modified Edmonton Symptom Assessment Scale (ESAS) at baseline and 1 week. Women had a worse baseline ESAS Distress Score (EDS; P = .003) and Total Distress Score (TDS; P = .005); differences were particularly marked for anxiety and appetite. Performance status was inversely associated with EDS, TDS, well-being, appetite, and fatigue (Kruskal-Wallis, all P < .005). Multivariate analysis of covariance (ANCOVA) showed that symptom improvement was independently predicted by worse baseline EDS score and female gender. Performance status, gender, and baseline symptom severity should be accounted for in trials of palliative care interventions; inclusion criteria based on symptom severity should also be considered.
Division of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Ontario, Canada. camilla.zimmermann@uhn.on.ca
Camilla
C
Zimmermann
Debika
D
Burman
Matthew
M
Follwell
Kristina
K
Wakimoto
Dori
D
Seccareccia
John
J
Bryson
Lisa W
LW
Le
Gary
G
Rodin
D000553:Ambulatory Care / Q000458:organization & administration / Q000523:psychology; D000704:Analysis of Variance; D000855:Anorexia / Q000209:etiology; D001007:Anxiety / Q000209:etiology; D005221:Fatigue / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis / Q000175:diagnosis / Q000517:prevention & control*; D009864:Ontario; D010166:Palliative Care / Q000458:organization & administration / Q000523:psychology; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013315:Stress, Psychological / Q000209:etiology; D016896:Treatment Outcome