Medical Oncology and Hematology, Princess Margaret Cancer Centre, and Department of Medicine, University of Toronto, Toronto, ON.
Hôpital du Sacré-Coeur, McGill University, Montreal, QC.
Curr Oncol. 2019 Dec;26(6):e733-e741. doi: 10.3747/co.26.5297. Epub 2019 Dec 1.
We assessed whether the presence and severity of common cancer symptoms are associated with the health utility score (hus) generated from the EQ-5D (EuroQol Research Foundation, Rotterdam, Netherlands) in patients with cancer and evaluated whether it is possible pragmatically to integrate routine hus and symptom evaluation in our cancer population.
Adult outpatients at Princess Margaret Cancer Centre with any cancer were surveyed cross-sectionally using the Edmonton Symptom Assessment System (esas) and the EQ-5D-3L, and results were compared using Spearman correlation coefficients and regression analyses.
Of 764 patients analyzed, 27% had incurable disease. We observed mild-to-moderate correlations between each esas symptom score and the hus (Spearman coefficients: -0.204 to -0.416; < 0.0001 for each comparison), with the strongest associations being those for pain ( = -0.416), tiredness ( = -0.387), and depression ( =-0.354). Multivariable analyses identified pain and depression as highly associated (both < 0.0001) and tiredness as associated ( = 0.03) with the hus. The ability of the esas to predict the hus was low, at 0.25. However, by mapping esas pain, anxiety, and depression scores to the corresponding EQ-5D questions, we could derive the hus using partial esas data, with Spearman correlations of 0.83-0.91 in comparisons with direct EQ-5D measurement of the hus.
The hus derived from the EQ-5D-3L is associated with all major cancer symptoms as captured by the esas. The esas scores alone could not predict EQ-5D scores with high accuracy. However, esas-derived questions assessing the same domains as the EQ-5D-3L questions could be mapped to their corresponding EQ-5D questions to generate the hus, with high correlation to the directly measured hus. That finding suggests a potential approach to integrating routine symptom and hus evaluations after confirmatory studies.
我们评估了常见癌症症状的存在和严重程度是否与癌症患者的 EQ-5D（荷兰鹿特丹欧洲质量基金会）生成的健康效用评分（HUS）相关，并评估了在我们的癌症人群中是否可以实际地将常规 HUS 和症状评估结合起来。
在玛格丽特公主癌症中心，使用埃德蒙顿症状评估系统（ESAS）和 EQ-5D-3L 对患有任何癌症的成年门诊患者进行横断面调查，并使用 Spearman 相关系数和回归分析比较结果。
在分析的 764 名患者中，27%的患者患有不可治愈的疾病。我们观察到每个 ESAS 症状评分与 HUS 之间存在轻度至中度相关性（Spearman 系数：-0.204 至-0.416；每次比较均<0.0001），最强的相关性是疼痛（=-0.416）、疲倦（=-0.387）和抑郁（=-0.354）。多变量分析确定疼痛和抑郁高度相关（均<0.0001），疲倦与 HUS 相关（=0.03）。ESAS 预测 HUS 的能力较低，为 0.25。然而，通过将 ESAS 的疼痛、焦虑和抑郁评分映射到相应的 EQ-5D 问题，我们可以使用部分 ESAS 数据推导出 HUS，与直接 EQ-5D 测量 HUS 的 Spearman 相关系数为 0.83-0.91。
EQ-5D-3L 衍生的 HUS 与 ESAS 所捕获的所有主要癌症症状相关。ESAS 评分本身无法准确预测 EQ-5D 评分。然而，评估与 EQ-5D-3L 问题相同领域的 ESAS 衍生问题可以映射到其对应的 EQ-5D 问题以生成 HUS，与直接测量的 HUS 高度相关。这一发现表明，在经过确认性研究后，整合常规症状和 HUS 评估可能是一种方法。
