Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
J Pain Symptom Manage. 2013 Aug;46(2):192-200. doi: 10.1016/j.jpainsymman.2012.07.022. Epub 2012 Nov 22.
Longitudinal symptom monitoring is important in the setting of patients with advanced cancer. Scores over time may naturally fluctuate, although a patient may feel the same.
The purpose of this study was to determine the minimal levels of change required to be clinically relevant (minimal clinically important difference [MCID]) using the Edmonton Symptom Assessment System (ESAS).
Between 1999 and 2009, patients completed the ESAS before palliative radiotherapy and at follow-up. MCIDs were calculated using both the anchor- and distribution-based methods for improvement and deterioration; 95% confidence intervals for the differences in mean change scores between adjacent categories also were calculated.
A total of 276 patients completed the ESAS at baseline and during at least one follow-up visit. At the four-week follow-up, decrease of 1.2 and 1.1 units in pain and depression scales, respectively, constituted clinically relevant improvement, whereas increase of at least 1.4, 1.8, 1.1, 1.1, and 1.4 units, respectively, in pain, tiredness, depression, anxiety, and appetite loss items were required for deterioration. At the subsequent follow-ups, these values were similar. Overall, the MCID for improvement tended to be smaller than that for deterioration. The distribution-based method estimates tended to be larger than the 0.3 SD estimates, but closer to the 0.5 SD estimates.
MCIDs allow health care professionals to determine the success of treatment in improving the patient's quality of life. MCIDs may prompt health care professionals to intervene with new treatment. Future studies should confirm our findings with a variety of anchors.
在晚期癌症患者中，进行纵向症状监测非常重要。尽管患者可能感觉相同，但分数随时间推移可能会自然波动。
本研究旨在使用埃德蒙顿症状评估系统（ESAS）确定需要达到临床相关的最小变化水平（最小临床重要差异[MCID]）。
1999 年至 2009 年间，患者在姑息性放疗前和随访时完成了 ESAS。使用基于锚定和分布的方法计算改善和恶化的 MCID；还计算了相邻类别之间平均变化分数差异的 95%置信区间。
共有 276 名患者在基线和至少一次随访时完成了 ESAS。在四周随访时，疼痛和抑郁量表分别下降 1.2 和 1.1 个单位被认为是临床相关的改善，而疼痛、疲劳、抑郁、焦虑和食欲丧失项目分别至少增加 1.4、1.8、1.1、1.1 和 1.4 个单位则被认为是恶化。在随后的随访中，这些值相似。总体而言，改善的 MCID 往往小于恶化的 MCID。基于分布的方法估计值往往大于 0.3 SD 估计值，但更接近 0.5 SD 估计值。
MCID 使医疗保健专业人员能够确定治疗是否成功改善了患者的生活质量。MCID 可能促使医疗保健专业人员采用新的治疗方法。未来的研究应使用各种锚定物来证实我们的发现。
