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Volume 26
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Article

Combined Cancer Patient–Reported Symptom and Health Utility Tool for Routine Clinical Implementation: A Real-World Comparison of the ESAS and EQ-5D in Multiple Cancer Sites

by
M. Moskovitz
1,2,*,
K. Jao
2,3,
J. Su
4,
M. C. Brown
2,
H. Naik
2,5,
L. Eng
2,
T. Wang
2,6,
J. Kuo
2,
Y. Leung
7,
W. Xu
4,
N. Mittmann
8,9,
L. Moody
8,
L. Barbera
8,9,
G. Devins
7,10,†,
M. Li
7,†,
D. Howell
7,11,† and
G. Liu
2,12,†
1
Thoracic Medical Oncology Service, Rambam MC, Haifa, Israel
2
Medical Oncology and Hematology, Princess Margaret Cancer Centre, and Department of Medicine, University of Toronto, Toronto, ON, Canada
3
Hôpital du Sacré-Coeur, McGill University, Montreal, QC, Canada
4
Department of Biostatistics, Ontario Cancer Institute, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
5
Department of Medicine, University of British Columbia, Vancouver, BC, Canada
6
Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
7
Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
8
Cancer Care Ontario,Toronto, ON, Canada
9
Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
10
Department of Psychiatry, University of Toronto, Toronto, ON, Canada
11
Lawrence Bloomberg School of Nursing, University of Toronto, Toronto, ON, Canada
12
Department of Epidemiology, Dalla Lana School of Public Health, Department of Medical Biophysics, and Institute of Medical Science, University of Toronto, Toronto, ON, Canada
 
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*
Author to whom correspondence should be addressed.
†
These authors contributed equally to the present work.
Curr. Oncol. 2019, 26(6), 733-741; https://doi.org/10.3747/co.26.5297
Submission received: 5 September 2019 / Revised: 4 October 2019 / Accepted: 3 November 2019 / Published: 1 December 2019

Abstract

Background: We assessed whether the presence and severity of common cancer symptoms are associated with the health utility score (HUS) generated from the EQ-5D (EuroQol Research Foundation, Rotterdam, Netherlands) in patients with cancer and evaluated whether it is possible pragmatically to integrate routine hus and symptom evaluation in our cancer population. Methods: Adult outpatients at Princess Margaret Cancer Centre with any cancer were surveyed cross-sectionally using the Edmonton Symptom Assessment System (ESAS) and the EQ-5D-3L, and results were compared using Spearman correlation coefficients and regression analyses. Results: Of 764 patients analyzed, 27% had incurable disease. We observed mild-to-moderate correlations between each ESAS symptom score and the HUS (Spearman coefficients: −0.204 to −0.416; p < 0.0001 for each comparison), with the strongest associations being those for pain (R = −0.416), tiredness (R = −0.387), and depression (R =−0.354). Multivariable analyses identified pain and depression as highly associated (both p < 0.0001) and tiredness as associated (p = 0.03) with the HUS. The ability of the ESAS to predict the HUS was low, at 0.25. However, by mapping ESAS pain, anxiety, and depression scores to the corresponding EQ-5D questions, we could derive the HUS using partial ESAS data, with Spearman correlations of 0.83–0.91 in comparisons with direct EQ-5D measurement of the HUS. Conclusions: The HUS derived from the EQ-5D-3L is associated with all major cancer symptoms as captured by the ESAS. The ESAS scores alone could not predict EQ-5D scores with high accuracy. However, ESAS-derived questions assessing the same domains as the EQ-5D-3L questions could be mapped to their corresponding EQ-5D questions to generate the HUS, with high correlation to the directly measured HUS. That finding suggests a potential approach to integrating routine symptom and HUS evaluations after confirmatory studies.
Keywords: value in cancer care; patient-reported outcomes value in cancer care; patient-reported outcomes

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MDPI and ACS Style

Moskovitz, M.; Jao, K.; Su, J.; Brown, M.C.; Naik, H.; Eng, L.; Wang, T.; Kuo, J.; Leung, Y.; Xu, W.; et al. Combined Cancer Patient–Reported Symptom and Health Utility Tool for Routine Clinical Implementation: A Real-World Comparison of the ESAS and EQ-5D in Multiple Cancer Sites. Curr. Oncol. 2019, 26, 733-741. https://doi.org/10.3747/co.26.5297

AMA Style

Moskovitz M, Jao K, Su J, Brown MC, Naik H, Eng L, Wang T, Kuo J, Leung Y, Xu W, et al. Combined Cancer Patient–Reported Symptom and Health Utility Tool for Routine Clinical Implementation: A Real-World Comparison of the ESAS and EQ-5D in Multiple Cancer Sites. Current Oncology. 2019; 26(6):733-741. https://doi.org/10.3747/co.26.5297

Chicago/Turabian Style

Moskovitz, M., K. Jao, J. Su, M. C. Brown, H. Naik, L. Eng, T. Wang, J. Kuo, Y. Leung, W. Xu, and et al. 2019. "Combined Cancer Patient–Reported Symptom and Health Utility Tool for Routine Clinical Implementation: A Real-World Comparison of the ESAS and EQ-5D in Multiple Cancer Sites" Current Oncology 26, no. 6: 733-741. https://doi.org/10.3747/co.26.5297

APA Style

Moskovitz, M., Jao, K., Su, J., Brown, M. C., Naik, H., Eng, L., Wang, T., Kuo, J., Leung, Y., Xu, W., Mittmann, N., Moody, L., Barbera, L., Devins, G., Li, M., Howell, D., & Liu, G. (2019). Combined Cancer Patient–Reported Symptom and Health Utility Tool for Routine Clinical Implementation: A Real-World Comparison of the ESAS and EQ-5D in Multiple Cancer Sites. Current Oncology, 26(6), 733-741. https://doi.org/10.3747/co.26.5297

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