Conway Jessica L, Felder Shira, Tang Jiayin, Lukovic Jelena, Han Kathy, Liu Zhihui, Milosevic Michael, Fyles Anthony, Croke Jennifer
Department of Radiation Oncology, University of Toronto, Ontario, Canada.
University Health Network, Princess Margaret Cancer Centre, Ontario, Canada.
Clin Transl Radiat Oncol. 2020 Apr 16;23:1-8. doi: 10.1016/j.ctro.2020.04.005. eCollection 2020 Jul.
To evaluate longitudinal patient-reported distress in cervical cancer patients treated with definitive chemoradiation (CRT).
Between 2011 and 2016, consenting cervical cancer patients treated with definitive CRT who completed ≥ 2 revised Edmonton Symptom Assessment System (ESAS-r) questionnaires at clinical visits, including baseline, were included. A linear mixed model was used to assess the longitudinal trend in ESAS-r. A minimal clinically important difference (MCID) for total ESAS-r score was defined as a change of 3-points for improvement and 4-points for deterioration. The proportion of patients with an MCID over time was described using moving averages. To test for changes, mixed effects logistic models were fitted, each of which included patient-specific random intercepts and random slopes.
67 patients were eligible for analysis (736 ESAS-r assessments). Median (range) follow-up was 24 months (range: 15-45) and compliance at 12 months was 60% (40/67). There was a significant decrease in ESAS-r scores over time. Baseline ESAS-r was strongly predictive of ESAS-r at follow-up (p < 0.001). The proportion of patients with an MCID for improvement from baseline significantly increased over time (p < 0.001) and the proportion with an MCID for deterioration significantly decreased over time (p < 0.001). No predictors for distress were found.
Long-term cervical cancer survivors experience distress that significantly improves over time to an extent expected to be clinically meaningful for patients. Implementing cervical cancer specific patient-reported outcome tools into practice could better inform patient needs.
评估接受根治性放化疗（CRT）的宫颈癌患者随时间推移的患者报告的痛苦程度。
纳入2011年至2016年间接受根治性CRT治疗且在包括基线在内的临床就诊时完成≥2份修订版埃德蒙顿症状评估系统（ESAS-r）问卷的宫颈癌患者。采用线性混合模型评估ESAS-r的纵向趋势。ESAS-r总分的最小临床重要差异（MCID）定义为改善3分和恶化4分。使用移动平均值描述随时间出现MCID的患者比例。为检验变化情况，拟合了混合效应逻辑模型，每个模型都包括患者特定的随机截距和随机斜率。
67例患者符合分析条件（736次ESAS-r评估）。中位（范围）随访时间为24个月（范围：15 - 45个月），12个月时的依从率为60%（40/67）。ESAS-r评分随时间显著降低。基线ESAS-r对随访时的ESAS-r有很强的预测性（p < 0.001）。从基线改善达到MCID的患者比例随时间显著增加（p < 0.001），而恶化达到MCID的患者比例随时间显著降低（p < 0.001）。未发现痛苦的预测因素。
长期宫颈癌幸存者经历的痛苦会随时间显著改善，达到对患者具有临床意义的程度。在实践中应用宫颈癌特异性患者报告结局工具可以更好地了解患者需求。
