title: Comparing baseline symptom severity and demographics over two time periods in an outpatient palliative radiotherapy clinic.
abstract: OBJECTIVE
  The primary objective of this study was to compare the symptom severity in two different patient populations assessed in an outpatient palliative radiotherapy clinic over two time periods spanning 10 years. The secondary objective was to assess any changes in the baseline demographics of these patients.
  
  
  METHODS
  Data were collected from 1999 to 2009. Upon initial presentation to the clinic, the Edmonton Symptom Assessment Scale (ESAS) was administered to patients to capture symptom severity. This validated assessment tool asks patients to score their level of pain, tiredness, nausea, depression, anxiety, drowsiness, loss of appetite, well-being, and dyspnea on an 11-point Likert scale. Differences between the two patient groups were assessed using chi-squared analysis and Wilcoxon rank-sum tests. A p value of <0.05 was considered significant.
  
  
  RESULTS
  A total of 1,439 patients completed the ESAS from 1999 to 2009. Patients were divided into two time periods 1999-2002 (n = 689) and 2006-2009 (n = 750). Pain, depression, nausea, fatigue, anxiety, drowsiness, and dyspnea were significantly better in 2006-2009 (p < 0.0001). Loss of appetite was not statistically different between the two time periods (p = 0.236). Significantly more patients with genitourinary cancers (p = 0.03) or a referral for a mass (p < 0.0001) were seen in 2006-2009. More patients with breast cancer (p = 0.04) and bone pain (p = 0.0002) were seen in 1999-2002. The median age was significantly higher (70 years vs. 68 years, p = 0.03) for patients seen in 2006-2009. No significant differences were seen in performance status or gender between the two groups.
  
  
  CONCLUSIONS
  There have been statistically significant lower scores in the severity of the majority of symptoms as scored by the latter patient cohort; however, whether this difference in magnitude is clinically significant is debatable. The reason for referral and demographics in patients sent for palliative radiotherapy has changed over a 10-year period. This may be a reflection of the changes in systemic therapies and improvements in supportive care for patients with advanced cancer.
authors.affiliation: Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
authors.forename: Luluel
authors.initials: L
authors.lastname: Khan
authors.forename: Justin
authors.initials: J
authors.lastname: Kwong
authors.forename: Janet
authors.initials: J
authors.lastname: Nguyen
authors.forename: Edward
authors.initials: E
authors.lastname: Chow
authors.forename: Liying
authors.initials: L
authors.lastname: Zhang
authors.forename: Shaelyn
authors.initials: S
authors.lastname: Culleton
authors.forename: Liang
authors.initials: L
authors.lastname: Zeng
authors.forename: Florencia
authors.initials: F
authors.lastname: Jon
authors.forename: May
authors.initials: M
authors.lastname: Tsao
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Barnes
authors.forename: Cyril
authors.initials: C
authors.lastname: Danjoux
authors.forename: Arjun
authors.initials: A
authors.lastname: Sahgal
authors.forename: Lori
authors.initials: L
authors.lastname: Holden
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D001007:Anxiety / Q000453:epidemiology; D016009:Chi-Square Distribution; D015331:Cohort Studies; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology; D018450:Disease Progression; D004417:Dyspnea / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D009325:Nausea / Q000453:epidemiology; D009362:Neoplasm Metastasis / Q000628:therapy; D009369:Neoplasms / Q000453:epidemiology* / Q000532:radiotherapy*; D010146:Pain / Q000453:epidemiology; D010166:Palliative Care / Q000706:statistics & numerical data*; D057285:Precision Medicine / Q000379:methods; D012720:Severity of Illness Index; D012894:Sleep Stages