Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Division of Medical Oncology and Hematology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Oncologist. 2021 Oct;26(10):e1800-e1811. doi: 10.1002/onco.13890. Epub 2021 Jul 17.
In Ontario, Canada, patient-reported outcome (PRO) evaluation through the Edmonton Symptom Assessment System (ESAS) has been integrated into clinical workflow since 2007. As stage IV non-small cell lung cancer (NSCLC) is associated with substantial disease and treatment-related morbidity, this province-wide study investigated moderate to severe symptom burden in this population.
ESAS collected from patients with stage IV NSCLC diagnosed between 2007 and 2018 linked to the Ontario provincial health care system database were studied. ESAS acquired within 12 months following diagnosis were analyzed and the proportion reporting moderate to severe scores (ESAS ≥4) in each domain was calculated. Predictors of moderate to severe scores were identified using multivariable Poisson regression models with robust error variance.
Of 22,799 patients, 13,289 (58.3%) completed ESAS (84,373 assessments) in the year following diagnosis. Patients with older age, with high comorbidity, and not receiving active cancer therapy had lower ESAS completion. The majority (94.4%) reported at least one moderate to severe symptom. The most prevalent were tiredness (84.1%), low well-being (80.7%), low appetite (71.7%), and shortness of breath (67.8%). Most symptoms peaked at diagnosis and, while declining, remained high in the following year. On multivariable analyses, comorbidity, low income, nonimmigrants, and urban residency were associated with moderate to severe symptoms. Moderate to severe scores in all ESAS domains aside from anxiety were associated with radiotherapy within 2 weeks prior, whereas drowsiness, low appetite and well-being, nausea, and tiredness were associated with systemic therapy within 2 weeks prior.
This province-wide PRO analysis showed moderate to severe symptoms were prevalent and persistent among patients with metastatic NSCLC, underscoring the need to address supportive measures in this population especially around treatments.
In this largest study of lung cancer patient-reported outcomes (PROs), stage IV non-small cell lung cancer patients had worse moderate-to-severe symptoms than other metastatic malignancies such as breast or gastrointestinal cancers when assessed with similar methodology. Prevalence of moderate-to-severe symptoms peaked early and remained high during the first year of follow-up. Symptom burden was associated with recent radiation and systemic treatments. Early and sustained PRO collection is important to detect actionable symptom progression, especially around treatments. Vulnerable patients (e.g., older, high comorbidity) who face barriers in attending in-person clinic visits had lower PRO completion. Virtual PRO collection may improve completion.
在加拿大安大略省，自 2007 年以来，通过埃德蒙顿症状评估系统（ESAS）进行的患者报告结局（PRO）评估已纳入临床工作流程。由于晚期非小细胞肺癌（NSCLC）与大量疾病和治疗相关的发病率相关，因此该全省范围的研究调查了该人群的中度至重度症状负担。
研究了 2007 年至 2018 年间诊断为晚期 NSCLC 的患者的 ESAS 数据，这些患者与安大略省的省级医疗保健系统数据库相关联。分析了诊断后 12 个月内获得的 ESAS，并计算了每个领域报告中度至重度评分（ESAS≥4）的比例。使用具有稳健误差方差的多变量泊松回归模型确定中度至重度评分的预测因素。
在 22799 名患者中，有 13289 名（58.3%）在诊断后一年内完成了 ESAS（84373 次评估）。年龄较大、合并症较多且未接受积极癌症治疗的患者完成 ESAS 的比例较低。大多数（94.4%）报告至少有一种中度至重度症状。最常见的是疲倦（84.1%）、幸福感低下（80.7%）、食欲减退（71.7%）和呼吸急促（67.8%）。大多数症状在诊断时达到高峰，尽管有所下降，但在随后的一年中仍保持较高水平。在多变量分析中，合并症、低收入、非移民和城市居住与中度至重度症状相关。ESAS 所有领域的中度至重度评分除焦虑外，与 2 周内之前的放疗相关，而嗜睡、食欲和幸福感低下、恶心和疲倦与 2 周内之前的系统治疗相关。
这项全省范围的 PRO 分析表明，转移性 NSCLC 患者存在中度至重度症状，且普遍存在且持续存在，这凸显了在该人群中特别需要解决支持性措施，尤其是在治疗方面。
在这项最大的肺癌患者报告结局（PRO）研究中，与乳腺癌或胃肠道癌等其他转移性恶性肿瘤相比，晚期非小细胞肺癌患者的中重度症状更为严重，采用类似的方法进行评估。中度至重度症状的患病率在早期达到高峰，并在随访的第一年保持较高水平。症状负担与近期放疗和系统治疗有关。早期和持续的 PRO 采集对于检测可治疗的症状进展非常重要，尤其是在治疗周围。参加面对面诊所就诊存在障碍的脆弱患者（例如年龄较大、合并症较多）的 PRO 完成率较低。虚拟 PRO 采集可能会提高完成率。
