Changes in symptom intensity among cancer patients receiving outpatient palliative care.
CONTEXT
Symptom changes are usually reported using summary statistics such as mean and/or median, which may obscure the treatment effect.


OBJECTIVES
The main objective of this retrospective study was to determine the magnitude of symptom changes as assessed by the Edmonton Symptom Assessment System (ESAS) after outpatient palliative care at the first follow-up visit.


METHODS
We reviewed 1612 consecutive patients with cancer who were referred to the outpatient Supportive Care Center and who completed the ESAS at the initial and first follow-up visits between January 2003 and December 2010. All patients received interdisciplinary care led by the palliative care specialists following an institutional protocol.


RESULTS
The distribution of the magnitude of symptom changes was stratified by baseline intensities. Patterns were similar for different ESAS items. At the follow-up visit (median: 15 days later), 52-74% of patients showed a decrease of one or more points in the ESAS score. However, 48-80% of patients with moderate/severe intensity at baseline complained of symptoms with an ESAS score of four or more after outpatient palliative care. Symptoms with absent/mild intensity worsened, ranging from a mean of -3.04 to 0.12 at the first follow-up visit, whereas symptoms with moderate/severe intensity improved from -0.2 to 3.86 (P<0.001).


CONCLUSION
A considerable proportion of patients with moderate or severe intensity at baseline still had symptoms with an ESAS score of four or more. Patients with absent/mild intensities at baseline complained of symptom exacerbation at the first follow-up visit. Various strategies are needed to optimize symptom control in advanced cancer.
['Kang|Jung Hun|JH|', 'Kwon|Jung Hye|JH|', 'Hui|David|D|', 'Yennurajalingam|Sriram|S|', 'Bruera|Eduardo|E|']
D017677:Age Distribution D000553:Ambulatory Care D015897:Comorbidity D005221:Fatigue D005260:Female D006801:Humans D008297:Male D001523:Mental Disorders D008875:Middle Aged D009369:Neoplasms D010146:Pain D010166:Palliative Care D015995:Prevalence D012189:Retrospective Studies D018570:Risk Assessment D012720:Severity of Illness Index D017678:Sex Distribution D063189:Symptom Assessment D013781:Texas D016896:Treatment Outcome
Symptom symptom intensity outpatient palliative care assessment