癌症患者 31866 例 SPPADE 症状的患病率、严重程度和共病情况。
Prevalence, Severity, and Co-Occurrence of SPPADE Symptoms in 31,866 Patients With Cancer.
机构信息
Indiana University School of Medicine (K.K.), Indianapolis, Indiana, USA; Regenstrief Institute, Inc. (K.K.), Indianapolis, Indiana, USA.
Department of Physical Medicine and Rehabilitation (V.L., A.L.C.), Mayo Clinic, Rochester, Minnesota, USA.
出版信息
J Pain Symptom Manage. 2023 May;65(5):367-377. doi: 10.1016/j.jpainsymman.2023.01.020. Epub 2023 Feb 2.
OBJECTIVES
To examine the prevalence, severity, and co-occurrence of SPPADE symptoms as well as their association with cancer type and patient characteristics.
BACKGROUND
The SPPADE symptoms (sleep disturbance, pain, physical function impairment, anxiety, depression, and low energy /fatigue) are prevalent, co-occurring, and undertreated in oncology and other clinical populations.
METHODS
Baseline SPPADE symptom data were analyzed from the E2C2 study, a stepped wedge pragmatic, population-level, cluster randomized clinical trial designed to evaluate a guideline-informed symptom management model targeting the six SPPADE symptoms. Symptom prevalence and severity were measured with a 0-10 numeric rating (NRS) scale for each of the six symptoms. Prevalence of severe (NRS ≥ 7) and potential clinically relevant (NRS ≥ 5) symptoms as well as co-occurrence of clinical symptoms were determined. Distribution-based methods were used to estimate the minimally important difference (MID). Associations of cancer type and patient characteristics with a SPPADE composite score were analyzed.
RESULTS
A total of 31,886 patients were assessed for SPPADE symptoms prior to, during, or soon after an outpatient medical oncology encounter. The proportion of patients with a potential clinically relevant symptom ranged from 17.5% for depression to 33.4% for fatigue. Co-occurrence of symptoms was high, with the proportion of patients with three or more additional clinically relevant symptoms ranging from 45.2% for fatigue to 68.6% for depression. The summed SPPADE composite score demonstrated good internal reliability (Cronbach's alpha of 0.86), with preliminary MID estimates of 4.1-4.3. Symptom burden differed across several types of cancer but was generally similar across most sociodemographic characteristics.
CONCLUSION
The high prevalence and co-occurrence of SPPADE symptoms in patients with all types of cancer warrants clinical approaches that optimize detection and management.
目的
调查 SPPADE 症状（睡眠障碍、疼痛、身体功能障碍、焦虑、抑郁和低能量/疲劳）的流行程度、严重程度和共病情况，以及它们与癌症类型和患者特征的关系。
背景
SPPADE 症状在肿瘤学和其他临床人群中普遍存在、共病且治疗不足。
方法
对 E2C2 研究的 SPPADE 症状基线数据进行分析，该研究是一项基于阶梯式楔形的实用、人群水平、聚类随机临床试验，旨在评估一种针对六种 SPPADE 症状的基于指南的症状管理模式。采用 0-10 数字评分（NRS）量表对六种症状中的每一种进行症状的流行程度和严重程度的测量。确定严重（NRS≥7）和潜在临床相关（NRS≥5）症状的流行程度以及临床症状的共病情况。使用基于分布的方法估计最小临床重要差异（MID）。分析癌症类型和患者特征与 SPPADE 综合评分的关系。
结果
在门诊肿瘤学就诊前、就诊期间或就诊后不久，对 31886 名患者进行了 SPPADE 症状评估。潜在临床相关症状的患者比例从抑郁的 17.5%到疲劳的 33.4%不等。症状的共病情况较高，疲劳的患者中有 45.2%，抑郁的患者中有 68.6%，同时存在三种或更多其他潜在临床相关症状。综合 SPPADE 复合评分具有良好的内部可靠性（Cronbach's alpha 为 0.86），初步 MID 估计值为 4.1-4.3。几种类型的癌症之间的症状负担存在差异，但在大多数社会人口统计学特征方面基本相似。
结论
所有类型癌症患者 SPPADE 症状的高流行率和共病情况需要采取优化检测和管理的临床方法。
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