title: Personalized symptom goals and response in patients with advanced cancer.
abstract: Improving symptoms is a major goal of cancer medicine; however, symptom response is often based on group differences and not individualized. In the current study, the authors examined the personalized symptom goal (PSG) for 10 common symptoms in patients with advanced cancer, and identified the factors associated with PSG response.
  
  
  
  In this prospective, longitudinal, multicenter study, patients from 5 tertiary care hospitals rated the intensity of 10 symptoms using a numeric rating scale of 0 to 10 at the time of their first clinic visit and then at a second visit 14 to 34 days later. The PSG was determined for each symptom by asking patients: "At what level would you feel comfortable with this symptom?" using the same scale of 0 to 10 for symptom intensity. PSG response was defined as symptom intensity at the time of the second visit that was less than or equal to the PSG.
  
  
  
  Among 728 patients, the median PSG was 1 for nausea; 2 for depression, anxiety, drowsiness, well-being, dyspnea, and sleep; and 3 for pain, fatigue, and appetite. A greater percentage of patients achieved a PSG response at their second visit compared with their first visit (P<.05 except for drowsiness). Symptom response was associated with lower baseline symptom intensity based on PSG criterion but higher baseline symptom intensity based on the traditional minimal clinically important difference definition (P<.001 for all symptoms). In multivariable analysis, higher PSG and nationality were associated with greater PSG response.
  
  
  
  The PSG was ≤3 for a majority of patients. PSG response allows clinicians to tailor treatment goals while adjusting for individual differences in scale interpretation and factors associated with symptom response. Cancer 2016;122:1774-81. © 2016 American Cancer Society.
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: David
authors.initials: D
authors.lastname: Hui
authors.affiliation: Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Minjeong
authors.initials: M
authors.lastname: Park
authors.affiliation: Department of Palliative Care, King Hussein Cancer Center, Amman, Jordan.
authors.forename: Omar
authors.initials: O
authors.lastname: Shamieh
authors.affiliation: Department of Medical Oncology, Barretos Cancer Hospital, Barretos, Brazil.
authors.forename: Carlos Eduardo
authors.initials: CE
authors.lastname: Paiva
authors.affiliation: Department of Internal Medicine, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile.
authors.forename: Pedro Emilio
authors.initials: PE
authors.lastname: Perez-Cruz
authors.affiliation: Department of Palliative Care, Tata Memorial Center, Mumbai, India.
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Muckaden
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000628:therapy; D001066:Appetite; D003863:Depression / Q000628:therapy; D004417:Dyspnea / Q000628:therapy; D005221:Fatigue / Q000628:therapy; D005260:Female; D006040:Goals; D006801:Humans; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000628:therapy; D009369:Neoplasms / Q000150:complications / Q000473:pathology / Q000628:therapy*; D010166:Palliative Care / Q000379:methods*; D011446:Prospective Studies; D063189:Symptom Assessment / Q000145:classification*; D013997:Time Factors; D016896:Treatment Outcome
keywords: neoplasms; palliative care; personalized medicine; symptom assessment; treatment outcome