title: Factors associated with patient-reported subjective well-being among advanced lung or non-colonic gastrointestinal cancer patients.
abstract: The aim of this study was to determine the factors associated with a feeling of well-being using the Edmonton Symptom Assessment Scale (ESAS)-Feeling of Well-Being item (ESAS-FWB; where 0 = best and 10 = worst) among advanced lung or non-colonic gastrointestinal cancer patients who were referred to an outpatient palliative care clinic (OPCC). We also examined the association of performance on the ESAS-FWB with overall survival (OS).
  
  
  
  We reviewed the records of consecutive patients with incurable advanced lung cancer and non-colonic gastrointestinal cancer presenting to an OPCC from 1 January 2008 through to 31 December 2013. Descriptive statistics were employed to summarize patient characteristics. Multivariate regression analysis was used to determine the factors associated with ESAS-FWB severity. We also examined the association of ESAS-FWB scores and survival using Kaplan-Meier survival analysis.
  
  
  
  A total of 826 evaluable patients were analyzed (median age = 62 years, 57% male). Median ESAS-FWB scores were five times the interquartile range (5 × IQR; 3-7). ESAS-FWB score was found to be significantly associated with ESAS fatigue (OR = 2.31, p < 0.001); anxiety (OR = 1.98, p < 0.001); anorexia (OR = 2.31, p < 0.001); cut down, annoyed, guilty, eye opener (CAGE) score (hazard ratio [HR] = 1.80, p = 0.008); and family caregiver distress (HR = 1.93, p = 0.002). A worse ESAS-FWB score was significantly associated with decreased OS (r = -0.18, p < 0.001). However, ESAS-FWB score was not independently associated with OS in the final multivariate model (p = 0.35), which included known major clinical prognostic factors.
  
  
  
  Worse ESAS-FWB scores were significantly associated with high scores on ESAS fatigue, anorexia, anxiety, CAGE, and family caregiver distress. More research is necessary to understand how palliative care interventions are capable of improving the contributory factors related to ESAS-FWB score.
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine,The University of Texas MD Anderson Cancer Center,Houston,Texas,USA.
authors.forename: Sriram
authors.initials: S
authors.lastname: Yennurajalingam
authors.affiliation: Division of Hematology and Medical Oncology, Department of Internal Medicine;Seoul National University, Bundang Hospital, Seoul National University College of Medicine,Seongnam,Republic of Korea.
authors.forename: Yu Jung
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Department of Medical Oncology,Shanghai University of Traditional Chinese Medicine,Shuguang Hospital,Shanghai,China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Division of Hematology and Oncology, Department of Internal Medicine; Daejeon St. Mary's Hospital,The Catholic University of Korea,Daejeon,Republic of Korea.
authors.forename: Jichan
authors.initials: J
authors.lastname: Park
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine,The University of Texas MD Anderson Cancer Center,Houston,Texas,USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Arthur
authors.affiliation: Department of Gynecology Oncology, and Reproductive Medicine,The University of Texas MD Anderson Cancer Center,Houston,Texas,USA.
authors.forename: Gary B
authors.initials: GB
authors.lastname: Chisholm
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine,The University of Texas MD Anderson Cancer Center,Houston,Texas,USA.
authors.forename: Janet L
authors.initials: JL
authors.lastname: Williams
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine,The University of Texas MD Anderson Cancer Center,Houston,Texas,USA.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
mesh_terms: D000368:Aged; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000150:complications / Q000523:psychology; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000523:psychology; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods / Q000523:psychology* / Q000592:standards; D017060:Patient Satisfaction; D011594:Psychometrics / Q000295:instrumentation / Q000379:methods; D011788:Quality of Life / Q000523:psychology*; D012307:Risk Factors; D063189:Symptom Assessment / Q000379:methods
keywords: Advanced cancer; Feeling of well-being; Outpatient supportive care; Symptom control