Symptom burden and performance status in a population-based cohort of ambulatory cancer patients.
BACKGROUND
For ambulatory cancer patients, Ontario has standardized symptom and performance status assessment population-wide, using the Edmonton Symptom Assessment System (ESAS) and Palliative Performance Scale (PPS). In a broad cross-section of cancer outpatients, the authors describe the ESAS and PPS scores and their relation to patient characteristics.


METHODS
This is a descriptive study using administrative healthcare data.


RESULTS
The cohort included 45,118 and 23,802 patients' first ESAS and PPS, respectively. Fatigue was most prevalent (75%), and nausea least prevalent (25%) in the cohort. More than half of patients reported pain or shortness of breath; about half of those reported moderate to severe scores. Seventy-eight percent had stable performance status scores. On multivariate analysis, worse ESAS outcomes were consistently seen for women, those with comorbidity, and those with shorter survivals from assessment. Lung cancer patients had the worst burden of symptoms.


CONCLUSIONS
This is the first study to report ESAS and PPS scores in a large, geographically based cohort with a full scope of cancer diagnoses, including patients seen earlier in the cancer trajectory (ie, treated for cure). In this ambulatory cancer population, the high prevalence of numerous symptoms parallels those reported in palliative populations and represents a target for improved clinical care. Differences in outcomes for subgroups require further investigation. This research sets the groundwork for future research on patient and provider outcomes using linked administrative healthcare data.
Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada. lisa.barbera@sunnybrook.ca
Lisa
L
Barbera
Hsien
H
Seow
Doris
D
Howell
Rinku
R
Sutradhar
Craig
C
Earle
Ying
Y
Liu
Audra
A
Stitt
Amna
A
Husain
Jonathan
J
Sussman
Deborah
D
Dudgeon
D000368:Aged; D000553:Ambulatory Care; D001007:Anxiety / Q000453:epidemiology; D019992:Databases as Topic; D003863:Depression / Q000453:epidemiology; D004417:Dyspnea / Q000453:epidemiology; D005221:Fatigue / Q000453:epidemiology; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis* / Q000628:therapy; D010146:Pain / Q000453:epidemiology; D011159:Population Surveillance; D011788:Quality of Life; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D016896:Treatment Outcome