title: Symptom improvement as prognostic factor for survival in cancer patients undergoing palliative care: a pilot study.
abstract: BACKGROUND
  The Edmonton Symptom Assessment Scale (ESAS) is a validated tool for physical symptom assessment in palliative care practice which evaluates symptoms through a numeric scale from 0 to 10. The use of symptom improvement as a prognostic factor is controversial. To this purpose, a pilot study in advanced cancer patients now undergoing only palliative care was conducted.
  
  
  METHODS
  Patients were considered eligible if no longer able to receive any anticancer treatment; they were scheduled to undergo ESAS assessment at the hospitalization and hospital discharge time points. Symptoms' scores were divided into three severity classes: mild, moderate and severe. Differences across symptoms' classes between hospitalization and hospital discharge time points were analysed with the paired-data McNemar test, according to tumour types.
  
  
  RESULTS
  ESAS assessment was administered to 68 patients with gastrointestinal (39 patients) and non-small cell lung cancer (29 patients); median age was 69 years; Karnofsky Performance Status was 50 in 27 (39.7%) patients and >50 in 41 (60.3%) patients. Palliative Prognostic Score was A for 26 (38.2%) patients, B for 37 (54.4%) patients and C for 5 (7.4%) patients. A statistically significant reduction of severe severity class rates was observed. Symptom improvement correlates with survival improvement: Palliative Prognostic Score (hazard ratio (HR) 2.95, 95% CI 1.35-6.41, p = 0.006) and anorexia (HR 3.21, 95% 1.33-7.72, p = 0.009) appear to be prognostic factors for survival at the multivariate analysis for gastrointestinal cancer patients; asthenia is the only significant variable (HR 5.11, 95% CI 1.86-14.03, p = 0.002) for non-small cell lung cancer patients.
  
  
  CONCLUSIONS
  Symptom improvement according to ESAS after palliative care treatment represents an important prognostic for survival in patients no longer suitable to receive any anticancer active therapies.
authors.affiliation: Medical Oncology Unit, Ospedale S.S. Trinità, Sora, ASL Frosinone, Italy.
authors.forename: Filomena
authors.initials: F
authors.lastname: Narducci
authors.forename: Roberta
authors.initials: R
authors.lastname: Grande
authors.forename: Lucia
authors.initials: L
authors.lastname: Mentuccia
authors.forename: Tiziana
authors.initials: T
authors.lastname: Trapasso
authors.forename: Isabella
authors.initials: I
authors.lastname: Sperduti
authors.forename: Emanuela
authors.initials: E
authors.lastname: Magnolfi
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Fariello
authors.forename: Donatello
authors.initials: D
authors.lastname: Gemma
authors.forename: Teresa
authors.initials: T
authors.lastname: Gamucci
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001247:Asthenia / Q000209:etiology; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000628:therapy*; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000473:pathology / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D017567:Karnofsky Performance Status; D008175:Lung Neoplasms / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010043:Outcome and Process Assessment, Health Care; D010166:Palliative Care / Q000379:methods*; D010865:Pilot Projects; D011379:Prognosis; D012720:Severity of Illness Index; D016019:Survival Analysis