Nieder Carsten, Kämpe Thomas A
Dept. of Oncology and Palliative Medicine, Nordland Hospital Trust.
Cureus. 2018 Jan 6;10(1):e2032. doi: 10.7759/cureus.2032.
Introduction Our department's standard work-flow includes assessment of all the patients with the Edmonton Symptom Assessment System (ESAS), a one-sheet questionnaire addressing 11 major symptoms and wellbeing on a numeric scale of zero-10, before the palliative radiotherapy (PRT). Based on previous research, we hypothesized that the patients with minimal or moderate total symptom burden might have better overall survival after the PRT than those with at least one higher symptom score. Methods We performed a retrospective analysis of 94 patients and calculated actuarial survival from the first day of the PRT (Kaplan-Meier method). We identified the patients with the score zero for all ESAS items (no symptoms), at least one item with score one-two (minimal symptoms), and at least one item with the score three (moderate symptoms). Results High proportions of the patients had ESAS scores zero- two for nausea (80%), sadness/depression (65%) and constipation (64%). The mean values were often in the range of two-four. Only one patient reported scores of zero throughout the questionnaire. He was treated for hematuria, a symptom that is not part of the ESAS. Three patients reported scores of zero-two throughout the questionnaire. Except for the performance status zero-one, their baseline characteristics were heterogeneous. Two patients reported scores not exceeding three for all items. These patients had excellent performance status, too. None of the six patients (6%) with relatively low ESAS scores of zero-three received care by the hospital's multidisciplinary palliative team. Only one was using opioid analgesics. The median survival for this small subset of six patients was six months, identical to the result for all the patients with higher symptom burden (p = 0.62). Conclusion The proportion of the patients with ESAS scores zero-three throughout the questionnaire was 6%, which resulted in the limited statistical power for the survival comparisons. The survival outcomes were similar. Before PRT, 94% of the patients reported at least one ESAS item of severity four-10. The symptoms not included in the questionnaire, e.g., hematuria might result in erroneous assignment to the low-symptom-burden group and obscure the prognostic impact of low ESAS symptom burden.
引言 我们科室的标准工作流程包括在姑息性放疗（PRT）前，使用埃德蒙顿症状评估系统（ESAS）对所有患者进行评估。ESAS是一张单页问卷，通过0至10的数字量表评估11种主要症状及健康状况。基于先前的研究，我们假设总症状负担最小或中等的患者在接受PRT后的总生存期可能比至少有一项症状评分较高的患者更好。方法 我们对94例患者进行了回顾性分析，并从PRT的第一天开始计算精算生存率（Kaplan-Meier法）。我们确定了ESAS所有项目评分为零（无症状）、至少一项评分为1至2（症状轻微）以及至少一项评分为3（症状中等）的患者。结果 大部分患者的恶心（80%）、悲伤/抑郁（65%）和便秘（64%）的ESAS评分为0至2。平均值通常在2至4之间。只有一名患者在整个问卷中报告的分数均为零。他因血尿接受治疗，血尿并非ESAS的一部分症状。三名患者在整个问卷中报告的分数为0至2。除了体能状态为0至1外，他们的基线特征各不相同。两名患者所有项目的报告分数均不超过3。这些患者的体能状态也很好。在ESAS评分为0至3的相对低分的6名患者中，没有一人接受过医院多学科姑息治疗团队的护理。只有一人使用阿片类镇痛药。这一小部分6名患者的中位生存期为6个月，与所有症状负担较高的患者结果相同（p = 0.62）。结论 在整个问卷中ESAS评分为0至3的患者比例为6%，这导致生存比较的统计效力有限。生存结果相似。在PRT前，94%的患者报告至少有一项ESAS项目的严重程度为4至10。问卷未包括的症状，如血尿，可能导致错误地归入低症状负担组，并掩盖低ESAS症状负担的预后影响。
