Department of Palliative Care and Rehabilitation Medicine,The University of Texas MD Anderson Cancer Center,Houston,Texas,USA.
Division of Hematology and Medical Oncology, Department of Internal Medicine;Seoul National University, Bundang Hospital, Seoul National University College of Medicine,Seongnam,Republic of Korea.
Palliat Support Care. 2018 Feb;16(1):23-31. doi: 10.1017/S1478951517000116. Epub 2017 Mar 7.
The aim of this study was to determine the factors associated with a feeling of well-being using the Edmonton Symptom Assessment Scale (ESAS)-Feeling of Well-Being item (ESAS-FWB; where 0 = best and 10 = worst) among advanced lung or non-colonic gastrointestinal cancer patients who were referred to an outpatient palliative care clinic (OPCC). We also examined the association of performance on the ESAS-FWB with overall survival (OS).
We reviewed the records of consecutive patients with incurable advanced lung cancer and non-colonic gastrointestinal cancer presenting to an OPCC from 1 January 2008 through to 31 December 2013. Descriptive statistics were employed to summarize patient characteristics. Multivariate regression analysis was used to determine the factors associated with ESAS-FWB severity. We also examined the association of ESAS-FWB scores and survival using Kaplan-Meier survival analysis.
A total of 826 evaluable patients were analyzed (median age = 62 years, 57% male). Median ESAS-FWB scores were five times the interquartile range (5 × IQR; 3-7). ESAS-FWB score was found to be significantly associated with ESAS fatigue (OR = 2.31, p < 0.001); anxiety (OR = 1.98, p < 0.001); anorexia (OR = 2.31, p < 0.001); cut down, annoyed, guilty, eye opener (CAGE) score (hazard ratio [HR] = 1.80, p = 0.008); and family caregiver distress (HR = 1.93, p = 0.002). A worse ESAS-FWB score was significantly associated with decreased OS (r = -0.18, p < 0.001). However, ESAS-FWB score was not independently associated with OS in the final multivariate model (p = 0.35), which included known major clinical prognostic factors.
Worse ESAS-FWB scores were significantly associated with high scores on ESAS fatigue, anorexia, anxiety, CAGE, and family caregiver distress. More research is necessary to understand how palliative care interventions are capable of improving the contributory factors related to ESAS-FWB score.
本研究旨在使用安大略省癌症治疗中心症状评估量表（ESAS）幸福感项目（ESAS-FWB；0 为最佳，10 为最差），确定接受姑息治疗门诊（OPCC）就诊的晚期肺癌或非结直肠胃肠道癌患者幸福感的相关因素。我们还研究了 ESAS-FWB 评分与总生存期（OS）的相关性。
我们回顾了 2008 年 1 月至 2013 年 12 月期间因晚期肺癌和非结直肠胃肠道癌到 OPCC 就诊的连续患者的病历。采用描述性统计方法总结患者特征。采用多变量回归分析确定与 ESAS-FWB 严重程度相关的因素。我们还通过 Kaplan-Meier 生存分析研究了 ESAS-FWB 评分与生存的关系。
共分析了 826 例可评估患者（中位年龄 62 岁，57%为男性）。ESAS-FWB 评分中位数为四分位距（IQR）的五倍（5 × IQR；3-7）。ESAS-FWB 评分与 ESAS 疲劳（OR = 2.31，p < 0.001）、焦虑（OR = 1.98，p < 0.001）、厌食（OR = 2.31，p < 0.001）、Cut down，annoyed，guilty，eye opener（CAGE）评分（HR = 1.80，p = 0.008）和家庭照顾者痛苦（HR = 1.93，p = 0.002）显著相关。ESAS-FWB 评分较差与 OS 降低显著相关（r = -0.18，p < 0.001）。然而，在最终的多变量模型中，ESAS-FWB 评分与 OS 无显著相关性（p = 0.35），该模型包括已知的主要临床预后因素。
ESAS-FWB 评分较差与 ESAS 疲劳、厌食、焦虑、CAGE 和家庭照顾者痛苦评分较高显著相关。需要进一步研究以了解姑息治疗干预措施如何改善与 ESAS-FWB 评分相关的促成因素。
