Predictors of high symptom burden in gynecologic oncology outpatients: who should be referred to outpatient palliative care?
OBJECTIVE
To characterize symptom prevalence in gynecologic oncology outpatients and identify predictors of high symptom burden.


METHODS
We performed a retrospective analysis of a convenience sample of symptom surveys from gynecologic oncology patients at a single cancer center over a 20-month period. The survey was based on the Edmonton Symptom Assessment System (ESAS), and assessed pain, depression, anxiety, fatigue and well-being. Information on demographics, disease, treatment and history of chronic pain, depression or anxiety was abstracted from medical records. Data was analyzed with descriptive and t-test statistics.


RESULTS
We analyzed 305 surveys from unique patients. Symptom prevalence (severity score>0/10) ranged from 60.1% (pain) to 79.7% (fatigue). Prevalence of moderate to severe symptoms (score≥4/10) ranged from 32% (pain) to 47% (fatigue). There were no differences in symptom burden by site or stage of cancer. Patients with no active disease (38%) were less symptomatic. There was a trend toward higher symptom burden in patients younger than 50years. There was higher symptom burden in patients receiving cancer treatment or with a pre-existing history of pain, anxiety or depression. Patients who expressed an interest in being seen by a symptom management service also had higher symptom burden.


CONCLUSIONS
Gynecologic oncology outpatients have a high symptom burden regardless of stage and site of cancer. Patients who are young, on treatment or have a history of chronic pain, depression or anxiety have a higher symptom burden. Consideration should be given to targeting these patients for outpatient palliative care services.
Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA 94117, USA. Electronic address: caseylefkowitscj@upmc.edu.
Carolyn
C
Lefkowits
Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA 94143-0320, USA.
Michael
M
W Rabow
Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Gynecologic Oncology, University of California San Francisco, San Francisco, CA 94117, USA.
Alexander
A
E Sherman
Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Gynecologic Oncology, University of California San Francisco, San Francisco, CA 94117, USA.
Tuyen
T
K Kiet
Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA 94117, USA.
Rachel
R
Ruskin
Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Gynecologic Oncology, University of California San Francisco, San Francisco, CA 94117, USA.
John K
JK
Chan
Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Gynecologic Oncology, University of California San Francisco, San Francisco, CA 94117, USA.
Lee-may
LM
Chen
D000368:Aged; D000553:Ambulatory Care / Q000379:methods*; D003266:Continuity of Patient Care; D003625:Data Collection; D005260:Female; D005833:Genital Neoplasms, Female / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D010045:Outpatients; D010166:Palliative Care / Q000379:methods*; D012017:Referral and Consultation; D012189:Retrospective Studies; D063189:Symptom Assessment / Q000379:methods
Gynecologic cancer; Palliative care; Symptom assessment; Symptom burden; Symptom management