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Symptom burden and performance status in a population-based cohort of ambulatory cancer patients
Version of Record online: 8 NOV 2010
Copyright © 2010 American Cancer Society
Volume 116, Issue 24, pages 5767–5776, 15 December 2010
How to Cite
Barbera, L., Seow, H., Howell, D., Sutradhar, R., Earle, C., Liu, Y., Stitt, A., Husain, A., Sussman, J. and Dudgeon, D. (2010), Symptom burden and performance status in a population-based cohort of ambulatory cancer patients. Cancer, 116: 5767–5776. doi: 10.1002/cncr.25681
- Issue online: 3 DEC 2010
- Version of Record online: 8 NOV 2010
- Manuscript Accepted: 31 AUG 2010
- Manuscript Revised: 13 AUG 2010
- Manuscript Received: 25 JUN 2010
- Edmonton Symptom Assessment System (ESAS);
- Palliative Performance Scale (PPS);
- population cohort, palliative care;
- health services research
For ambulatory cancer patients, Ontario has standardized symptom and performance status assessment population-wide, using the Edmonton Symptom Assessment System (ESAS) and Palliative Performance Scale (PPS). In a broad cross-section of cancer outpatients, the authors describe the ESAS and PPS scores and their relation to patient characteristics.
This is a descriptive study using administrative healthcare data.
The cohort included 45,118 and 23,802 patients' first ESAS and PPS, respectively. Fatigue was most prevalent (75%), and nausea least prevalent (25%) in the cohort. More than half of patients reported pain or shortness of breath; about half of those reported moderate to severe scores. Seventy-eight percent had stable performance status scores. On multivariate analysis, worse ESAS outcomes were consistently seen for women, those with comorbidity, and those with shorter survivals from assessment. Lung cancer patients had the worst burden of symptoms.
This is the first study to report ESAS and PPS scores in a large, geographically based cohort with a full scope of cancer diagnoses, including patients seen earlier in the cancer trajectory (ie, treated for cure). In this ambulatory cancer population, the high prevalence of numerous symptoms parallels those reported in palliative populations and represents a target for improved clinical care. Differences in outcomes for subgroups require further investigation. This research sets the groundwork for future research on patient and provider outcomes using linked administrative healthcare data. Cancer 2010. © 2010 American Cancer Society.