Search Results (41)

Background: Symptom burden and functional impairment are common in women with breast cancer, yet their prevalence and clinical significance across the disease spectrum remain underexplored. We sought to describe symptom burden and performance status using patient-reported outcome measures and to identify patient characteristics associated with symptoms requiring clinical intervention. Methods: In this cross-sectional study, women with stage I–IV breast cancer completed the Edmonton Symptom Assessment System (ESAS) and the Patient-Reported Functional Status tool. We assessed the prevalence and severity of symptoms and calculated summary distress scores. Multivariable logistic regression was used to identify patient characteristics associated with clinically significant symptoms (ESAS ≥ 4). Results: Among 381 women (mean age 56.8 years; 27% metastatic; 72% with no comorbidities), 70% reported at least one moderate to severe symptom. The most common were tiredness (31%), lack of well-being (30%), and anxiety (21%). Mean summary distress scores were low overall. Most patients reported functional status scores of 0 or 1, and 43% of those with scores ≥2 had metastatic disease. Compared with metastatic patients, women within the first year after diagnosis were less likely to report a symptom requiring intervention (OR 0.49, 95% CI 0.24–0.90). Conclusions: Clinically significant symptoms are common among women with breast cancer, including those with potentially curable disease. Threshold-based use of ESAS, rather than reliance on mean scores, provides a more accurate assessment of patient needs. These findings support the routine integration of patient-reported outcomes into oncology care and underscore the importance of targeted multidisciplinary interventions. Full article

Among adult advanced cancer patients already accessing palliative care, symptoms can contribute to unplanned acute care utilizations, which can disrupt care and worsen patient outcomes. We examined how a novel symptom complexity algorithm, using patients’ ratings of the nine Edmonton Symptom Assessment System—Revised (ESAS-r) symptoms to assign “low”, “medium”, or “high” complexity, predicts acute care utilizations. This retrospective observational cohort study used electronic medical record data from the Durham Regional Cancer Centre in Ontario, Canada, comprising adult advanced cancer patients who completed at least one ESAS-r report between 1 January 2022 and 31 December 2023. We applied chi-squared tests, Kruskal–Wallis H tests, and multivariable binary logistic regressions to evaluate factors associated with higher odds of acute care utilization within seven and fourteen days of patients’ first ESAS-r reports after their first palliative care interaction. Of 559 included patients, 125 (22.4%) exhibited low complexity, 180 (32.2%) exhibited medium complexity, and 254 (45.4%) exhibited high complexity on their first ESAS-r report. In total, 61 (10.9%) patients accessed acute care within seven days and 108 (19.3%) patients accessed acute care within fourteen days of their first ESAS-r report. Controlling for sociodemographic and clinical covariates, compared to low-complexity patients, high-complexity patients had higher odds of acute care utilization within seven days (aOR = 2.83, 95% CI: 1.18–6.77), but not within fourteen days (aOR = 1.78, 95% CI: 0.97–3.28). Accordingly, as a clinical decision-making tool, ESAS-r symptom complexity may help identify patients who would benefit from more intensive follow-up and potentially reduce unnecessary acute care utilizations. Full article

Background/Objective: Survival prediction in the advanced cancer care setting plays a vital role in treatment planning and patients’ arrangements. The aim of this study was to examine the association of the global Edmonton Symptom Assessment System (GESAS) and Karnofsky scale (KPS) with overall survival (OS) in patients with advanced cancers admitted to an acute palliative care unit (APCU). The second aim was to assess if GESAS changes after comprehensive palliative treatment could influence OS. Methods: This is a prospective planned sub-analysis of advanced cancer patients. A consecutive sample of 521 patients admitted to an APCU. Patients with available survival in follow-up phone calls, having complete ESAS, and discharged alive were selected. KPS and GESAS were measured at admission and after seven days of individual comprehensive palliative care. Results: Two hundred forty-three of 521 screened patients were assessed according to inclusion criteria. The mean age was 67.1 years (SD 11.5), and 121 patients were male. The mean KPS was 43.5 (SD 9.3). The mean OS was 74.6 (SD 136.2) days. Significant changes in GESAS were observed after one week. Univariate linear regression analysis showed that KPS and GESAS at T0 and at T7 were correlated with OS (p < 0.0005; p = 0.020; p < 0.0005, respectively). At multivariate analysis, OS was correlated with KPS and GESAS at discharge (B = 3.349, 95% CI = 1.560–5.137; B = −2.430, 95% CI = −3.831–−1.029). Discussion: KPS and poor response to intensive treatment, maintaining high GESAS scores, can be considered predictive factors of shorter OS. Further studies should confirm whether a specialized intervention in other settings can improve OS. Full article

Scope: The rationale of the present study is to measure the impact of chemotherapy on the pain caused by the disease. Materials and Methods: The present study was based on the completion of two standardized questionnaires for the assessment of physical symptoms (Brief Pain Inventory—BPI—and the revised Edmonton Symptom Assessment System—ESASr) in three different moments. The research was conducted at the Oncology Institute “Prof. Dr. Ion Chiricuță” Cluj-Napoca between 2022 and 2023. Results: 24 patients were included in the study, and they received different cytostatic treatment regimens, adapted to the underlying pathology. We analyzed the distribution of all symptoms from the ESASr and the total score. In terms of the general situation, if we exclude pain, there is never a difference between Time 2 and 3. Furthermore, in all cases where there is a statistically significant effect, there is a difference between Time 1 and 3. We also analyzed the distribution of activities with which pain interacts in BPI. Regarding the general situation, three patterns of influence of pain on the examined parameters are found: for general activity, mood, ability to work, and sleep, there are significant differences between moments 1 and 2 and 1 and 3, without significant differences between moments 2 and 3. The second pattern identified refers to the lack of effect of pain on the ability to walk and on the relationship with other people. The peculiarity is represented by the influence on the enjoyment of life that was significantly improved only from Time 1 to 3. Conclusions: The present study demonstrated a considerable effect of cytostatic treatment on the management of cancer-related pain, as shown across different evaluations. Full article

Introduction: Patients with transplant-ineligible (TIE) multiple myeloma (MM) have high rates of symptom burden. The aim of this study was to develop and validate a prognostic model to predict symptoms in patients with TIE MM. Methods: In this population-based, retrospective cohort study, using multiple administrative health care databases linked using a unique encrypted patient identifier in Ontario, Canada, symptoms were identified using the patient self-reported Edmonton Symptom Assessment System (ESAS) at each clinic visit. The primary outcome was the presence of moderate-to-severe (ESAS score 4–10) symptoms (specifically symptoms of pain, tiredness, depression, and impaired well-being) within one year from the index date. Using the entire cohort, a multivariable logistic regression model with baseline covariates was developed to predict the risk of experiencing each of the above symptoms, categorized as moderate to severe within 1 year post-index date. Internal validation of the model was assessed via bootstrap validation methods. Results: A total of 1535 TIE adults with MM met the inclusion criteria. The median age was 75, with 25.2% of patients aged 80 years or older. In the multivariate analysis, baseline symptoms continued to be most associated with future symptom burden. Baseline severe pain (OR 9.84, 95% CI 6.29–15.7) was most associated with patients experiencing moderate–severe pain one year post-index date. Similarly, baseline severe tiredness (OR 17.34, 95% CI 9.00–33.42), baseline severe depression (OR 28.07, 95% CI 15.96–49.38), and baseline severely impaired well-being (OR 4.12, 95% CI 2.30–7.37) were the biggest predictors of patients experiencing moderate–severe tiredness, depression, and impaired well-being, respectively, at one year after the index date. Conclusions: Patients with MM experience persisting symptoms of pain, tiredness, depression, and impaired well-being, with baseline symptoms being the biggest predictor of future symptom burden. Full article

Background: Breast cancer (BC) is the most common malignancy affecting women globally, significantly impacting their quality of life (QoL). This study aimed to assess the prevalence and severity of symptoms in newly diagnosed BC patients undergoing chemotherapy in Oman using the Edmonton Symptom Assessment System (ESAS-A); Materials and Methods: A cross-sectional study was conducted between December 2022 and February 2024 at the Sultan Qaboos Comprehensive Cancer Care and Research Centre (SQCCCRC), University Medical City, Oman. The study included 105 Omani women, aged 18 to 60, diagnosed with stage I to III BC and undergoing chemotherapy. Symptom evaluation was performed using ESAS-A. Descriptive statistics were employed to summarize socio-demographic characteristics and clinical outcomes, while the Mann–Whitney U test and multiple linear regression analysis were used to examine associations between independent variables and symptom scores; Results: Out of 127 invited participants, 105 (82.6%) agreed to participate. The average age was 43.6 years (SD = 7.2). Fatigue (37.1%), poor well-being (30.5%), and drowsiness (27.6%) were the most commonly reported symptoms. Anxiety and depression affected 21.9% and 17.1% of participants, respectively. Linear regression analysis showed that having children was linked to higher fatigue and shortness of breath, while inversely associated with pain. A family history of chronic disease was significantly correlated with higher depression scores; Conclusions: This study is the first in Oman to utilize ESAS-A for assessing symptom burden in newly diagnosed BC patients undergoing chemotherapy. The findings highlight the importance of personalized symptom management and enhanced supportive care to improve patient well-being. Full article

Background/Objectives: Cancer pain is prevalent across all stages of the disease, significantly impacting patients’ lives. Despite the availability of guidelines, its assessment and management remain suboptimal in many clinical settings. This study aimed to explore how healthcare professionals in Italy assess and manage cancer pain, identifying gaps and educational needs to improve adherence to best practices. Methods: A multidisciplinary Scientific Board designed an online survey comprising 28 items addressing demographics, pain assessment tools, perception of pain, pharmacological management, adverse effects, and barriers to care. The survey targeted oncologists, nurses, radiotherapists, and surgeons within the Italian Network of Supportive Care in Oncology. Data were collected from March to May 2024 and analyzed descriptively. Results: Eighty-five professionals participated, predominantly oncologists (63.5%). Most respondents utilized pain scales, with the Numerical Rating Scale (60.3%) being the most frequent. However, specific tools like the Edmonton Symptom Assessment System (ESAS) were underutilized, possibly due to limited training and time constraints. Factors influencing analgesic choice included patient comorbidities (30.3%) and polypharmacy (28.0%). The main barriers to effective pain management included inadequate training (85.5%) and poor communication between patients and caregivers (40.6%) and within care teams (31.9%). Preventive measures for opioid-induced adverse events were widely employed, with laxatives (52.7%) and antiemetics (40.5%) being the most common. Conclusions: Findings underscore the need for structured training programs, improved communication, and integration of validated assessment tools. A multidisciplinary, proactive approach to cancer pain assessment and management is essential to optimize care and reduce its burden across all disease stages. Full article

Introduction: Cancer patients in palliative care frequently experience psychological distress, encompassing cognitive, behavioral, and emotional dimensions. This distress can significantly affect their capacity to accept the inevitability of death. Commonly, such distress manifests as sadness, depression, anxiety, and fear, which may culminate in an existential crisis. Objectives: The purpose of this study was to analyze the psychometric properties of the Edmonton Symptom Assessment System (ESAS) and the Palliative Outcome Scale (POS) among hospitalized cancer patients receiving palliative care in a Portuguese palliative care unit. Methods: Data were collected from psychological screening instruments (ESAS and POS) used in oncology patients admitted to an oncology palliative service. The study period spanned from January 2021 to March 2021. Results: The study included a convenience sample of 60 patients diagnosed with advanced cancer who were sequentially admitted to a palliative care unit. The most frequently reported primary oncological diagnoses were gastrointestinal (41.7%) and head/neck (20%) tumors. The majority of the patients were male (n = 37; 61.7%), with a median age of 72 years (range: 43–94 years). Key findings from the analysis indicated the following associations: anxiety and self-reported symptoms (higher levels of patient anxiety related to illness or treatment were strongly correlated with increased self-reported anxiety (p < 0.01)); emotional sharing and perceived meaning of life (patients who shared their feelings less frequently with family and friends were significantly less likely to find meaning in life (p < 0.01) and were more likely to report a poorer self-perception (p < 0.05)); understanding the importance of life and self-perception (a diminished understanding of the importance of life was associated with worsened self-perception (p < 0.01)); anxiety and depressive symptoms (greater anxiety related to the disease or its treatment correlated with an increased severity of depressive symptoms (p < 0.01)). Discussion and conclusion: There are numerous validated instruments available for measuring emotional distress. Among these, the ESAS and POS complement each other as practical and easy-to-use tools for evaluating emotional distress in patients admitted to palliative care settings. Findings revealed that anxiety and concerns related to the disease and its treatment, as measured by the POS, served as predictors of the risk for self-reported anxiety and depression identified by the ESAS. Furthermore, the items within the POS that evaluate the emotional component demonstrated strong internal correlation, supporting their combined use for a comprehensive assessment of this dimension. Full article

Introduction. Anxiety and depression have an increased prevalence in cancer patients, especially in those in an advanced stage of the disease. These disorders have a major impact on the social life, existential concerns and quality of life of cancer patients. Materials and Methods. A number of 114 consecutive patients were included in the study (in a period of 2 weeks) who were screened for anxiety, depression and for other common symptoms, using Hospital Anxiety and Depression Scale (HADS) and Edmonton Symptom Assessment System (ESAS). Results. Regarding the age—the abnormal level of anxiety and depression: the percentage of patients over 65 years was higher than the percentage of patients under 64 years, both in terms of anxiety and depression. Regarding the Performance status ECOG—abnormal level of anxiety and depression: the percentage of patients with ECOG = 3–4 is higher than that of patients with ECOG = 0–2. Results. The increased prevalence of anxiety and depression requires psychological counseling and treatment. It is important for these symptoms to be identified as soon as possible, in order to provide a good quality of life. Conclusions. The model we propose is for the HADS to be a screening tool on admission to a palliative care ward, for certain categories of patients. Full article

Background: Although screening for distress is recommended by many cancer care guidelines, the uptake of such screening in cancer centers remains limited. Improving the acceptability of screening programs in cancer centers requires a reduction in clinical burden and an improved detection of distress. The purpose of this study was to validate the performance of the two-step screening algorithm used in the Distress Assessment and Response Tool (DART) for identifying cases of anxiety and depression. Methods: This retrospective validation study consisted of patients at the Princess Margaret Cancer Centre (PM) who completed the DART, which includes the Edmonton Symptom Assessment System depression (ESAS-D) and anxiety (ESAS-A) items, the Patient Health Questionnaire (PHQ-9), and the Generalized Anxiety Disorder (GAD-7). We evaluated the performance of a two-step screening approach, which modeled the ESAS-D, followed by the PHQ-9 and ESAS-A, then the GAD-7 for predicting a diagnosis of depression and anxiety disorders, respectively. A clinical psychiatric assessment was used as the gold standard reference. Results: A total of 172 patients with cancer were included in this study. A total of 59/172 (34%) and 39/172 (23%) were diagnosed with a depression or anxiety disorder, respectively. The sequential administration of the PHQ-9 ≥15 following the ESAS-D (>2) significantly increased the post-test probability of depression from 37% to 60% and improved the performance of predicting depression compared to both the ESAS-D or the PHQ-9 as standalone tests. The sequential administration of the GAD-7 after the ESAS-A did not improve the predictability of an anxiety diagnosis beyond the performance of the ESAS-A or the GAD-7 as standalone tests. Conclusions: The present study is among the first to demonstrate that a two-step screening algorithm for depression may improve depression screening in cancer using real-world data. Further research on optimal screening approaches for anxiety in cancer is warranted. Full article

Background: Patients with advanced cancer often endure a heavy burden of symptoms, both in quantity and intensity. Complementary therapies offer potential relief in this challenging scenario. Increasing the number of randomized controlled trials provides a unique opportunity to generate rigorous data, which can be used to establish causal relationships and evaluate interventions; hence, nurses can strengthen evidence-based practices, leading to better patient outcomes and quality of care. Our study aimed to evaluate the impact of a 7-day pre-recorded music intervention on cancer symptoms and satisfaction in advanced-stage cancer patients receiving palliative care at home. Methods: This multicenter, double-blind, randomized, controlled clinical trial involved 80 Spanish cancer patients receiving palliative care at home, and was conducted from July 2020 to November 2021. The intervention group (n = 40) received self-selected pre-recorded music for 30 min daily over 7 days. The control group (n = 40) received pre-recorded basic health education sessions of equal duration and frequency. Symptoms and patient satisfaction were assessed before and after the intervention using the Edmonton Symptom Assessment System and the Client Satisfaction Questionnaire, respectively. Results: Comparing the intervention with the control group, significant improvements were observed in various symptoms: total symptom burden (p < 0.001), pain (p = 0.001), fatigue (p = 0.007), depression (p = 0.001), anxiety (p = 0.005), drowsiness (p = 0.006), appetite (p = 0.047), well-being (p ≤ 0.001), and sleep (p < 0.001); additionally, patient satisfaction was higher in the intervention group (p < 0.001). Conclusions: The 7-day pre-recorded music intervention reduced both physical and psychological symptoms in advanced-stage cancer patients receiving home-based palliative care, demonstrating significant alleviation of overall symptom burden and increased satisfaction with healthcare. Full article

Cancer is the primary underlying condition for most Canadians who are provided Medical Assistance in Dying (MAID). However, it is unknown whether cancer patients who are provided MAID experience disproportionally higher symptom burden compared to those who are not provided MAID. Thus, we used a propensity-score-matched cohort design to evaluate longitudinal symptom trajectories over the last 12 months of patients’ lives, comparing cancer patients in Alberta who were and were not provided MAID. We utilized routinely collected retrospective Patient-Reported Outcomes (PROs) data from the Edmonton Symptom Assessment System (ESAS-r) reported by Albertans with cancer who died between July 2017 and January 2019. The data were analyzed using mixed-effect models for repeated measures to compare differences in symptom trajectories between the cohorts over time. Both cohorts experienced increasing severity in all symptoms in the year prior to death (β from 0.086 to 0.231, p ≤ .001 to .002). Those in the MAID cohort reported significantly greater anxiety (β = −0.831, p = .044) and greater lack of appetite (β = −0.934, p = .039) compared to those in the non-MAID cohort. The majority (65.8%) of patients who received MAID submitted their request for MAID within one month of their death. Overall, the MAID patients did not experience disproportionally higher symptom burden. These results emphasize opportunities to address patient suffering for all patients with cancer through routine collection of PROs as well as targeted and early palliative approaches to care. Full article

Background: Pain catastrophizing is a group of negative irrational cognitions in the context of anticipated or actual pain. The aim of this study was to decipher the possible role of catastrophism on pain expression and outcomes after a comprehensive palliative care treatment. Methods: A consecutive sample of patients with uncontrolled pain was assessed. Demographic characteristics, symptom intensity included in the Edmonton symptom assessment system (ESAS), and opioid drugs used were recorded at admission (T0). The Pain Catastrophizing Scale (PCS) was measured for patients. Patients were also asked about their personalized symptom goal (PSG) for each symptom of ESAS. One week after a comprehensive palliative care treatment (T7), ESAS and opioid doses used were recorded again, and the number of patients who achieved their PSG (PSGR) were calculated. At the same interval (T7), Minimal Clinically Important Difference (MCID) was calculated using patient global impression (PGI). Results: Ninety-five patients were eligible. A significant decrease in symptom intensity was reported for all ESAS items. PGI was positive for all symptoms, with higher values for pain, poor well-being, and poor sleep. Only the rumination subscale of catastrophism was significantly associated with pain at T0 (B = 0.540; p = 0.034). Conclusions: Catastrophism was not associated with the levels of pain intensity, PSG, PSGR, and PGI for pain, except the rumination subscale that was associated with pain intensity at T0. A comprehensive palliative care management provided the relevant changes in symptom burden, undoing the pain expression associated with rumination. Full article

Frailty is an important risk factor for adverse events (AEs), especially in elderly patients. Therefore, assessing frailty before therapy is recommended. In head and neck squamous cell carcinoma (HNSCC) patients, frailty is prognostic for severe postoperative complications and declining quality of life (QoL) after HNSCC treatment. Thus, assessment of frailty may help to identify individuals at risk for AE caused by oncologic therapy. We investigated the relationship between frailty and symptom burden to better understand their interaction and impact on HNSCC patients. In this prospectively designed cross-sectional study, the presence of frailty and symptom burden was assessed by using the Geriatric 8 (G8) and Minimal Documentation System (MIDOS²) questionnaires. A total of 59 consecutively accrued patients with a first diagnosis of HNSCC before therapy were evaluated. Patients were considered frail at a total G8 score ≤ 14. The MIDOS² symptom burden score was considered pathological with a total score ≥ 4 or any severe symptom (=3). Statistical correlations were analyzed using Spearman and Pearson correlation. Receiver operator characteristic (ROC) curves were used to analyze the potential of predicting frailty and MIDOS². p-values < 0.05 were considered significant. A total of 41 patients (69.5%) were considered frail, and 27 patients (45.8%) had increased symptom burden. “Tiredness” was the most common (overall rate 57.8%) and “Pain” was the most often stated “severe” symptom (5 patients, 8.5%). G8 and MIDOS² correlated significantly (ρ = −0.487, p < 0.001; r = −0.423, p < 0.001). Frailty can be predicted by MIDOS² symptom score (AUC = 0.808, 95% CI 0.698–0.917, p < 0.001). Vice versa, the G8 score can predict pathological symptom burden according to MIDOS² (AUC = 0.750, 95% CI 0.622–0.878, p < 0.001). Conclusions: The strong link between frailty and increased symptom burden assessed by G8 or MIDOS² indicates a coherence of both risk factors in HNSCC patients. Considering at least one of both scores might improve the identification of individuals at risk and achieve higher QoL and reduced complication rates by decision making for appropriate therapy regimens. Full article

Palliative care offers symptom relief and improved quality of life. Tertiary palliative care units (TPCUs) focus on complex suffering under the care of specialist palliative physicians and interdisciplinary teams. The Intensive Palliative Care Unit (IPCU) is a TPCU integrated in well-developed region-wide palliative services in Calgary, Canada. We compared the population accessing the IPCU to published data from other Canadian sites. Methods: A retrospective chart review was conducted using 8 sample months over a 2-year period. We gleaned psychosocial and medical demographics alongside the self-reported symptom burden on the Edmonton Symptom Assessment System. Descriptive statistics were calculated. Results: Adults (n = 117) with cancer admitted to the IPCU were 5–10 years younger, had later-stage cancer, and had higher discharges to preferred locations than other published Canadian TPCUs. Up to two months before admission, most commonly reported symptoms were consistent with the outpatient literature although with higher reported intensity. Discussion: With more advanced disease, younger age, and elevated symptom burden before admission, the IPCU still discharged patients to preferred locations at higher rates than other sites. This may be due to integration in the region’s organized palliative care services. Conclusion: With proper integration, a TPCU may be able to improve quality of life and reduce deaths in hospitals. Full article