Heinzelmann Anna, Tewes Mitra, Müller Sandy, Sure Ulrich, Herrmann Ken, Schadendorf Dirk, Warnecke Eva, Rausch Raya, Skoda Eva-Maria, Salvador Comino Maria Rosa
Department of Palliative Medicine, University Hospital Essen (AöR), 45147, Essen, Germany.
Department of Neurosurgery, University Hospital Essen (AöR), 45147, Essen, Germany.
J Cancer Res Clin Oncol. 2024 Jul 24;150(7):360. doi: 10.1007/s00432-024-05897-x.
The Minimal Documentation System (MIDOS2) is recommended as a systematic screening tool for assessing symptom burden and patient needs in advanced cancer patients. Given the absence of an optimal weighting of individual symptoms and a corresponding cut-off value, this study aims to determine a threshold based on inpatient's subjective need for palliative support. Additionally, we investigate the correlation between symptom burden and subjective need for palliative support collected through a patient-reported outcome measure (PROM) with survival duration of less or more than one year.
Inpatients diagnosed with advanced solid cancer completed an electronic PROM, which included the MIDOS2 questionnaire among other tools. Differences in symptom burden were analysed between patients expressing subjective need for palliative support and those with survival of less or more than one year using ANOVA, Mann-Whitney-U Test, logistic regression, Pearson and Spearman correlation tests. Cut-off analyses were performed using a ROC curve. Youden-Index, sensitivity, and specificity measures were used as well.
Between April 2020 and March 2021, 265 inpatients were included in the study. Using a ROC curve, the MIDOS2 analysis resulted in an Area under the curve (AUC) of 0.732, a corresponding cut-off value of eight points, a sensitivity of 76.36% and a specificity of 62.98% in assessing the subjective need for palliative support. The MIDOS2, with double weighting of the significant symptoms, showed a cut-off value of 14 points, achieving a sensitivity of 78.18% and a specificity of 72.38%. A total of 55 patients (20.8%) expressed a need for support from the palliative care team. This need was independent of the oncological tumour entity and increased among patients with a survival of less than one year. These patients reported significantly poorer physical (p < 0.001) or mental (p < 0.001) condition. Additionally, they reported higher intensities of pain (p = 0.002), depressive symptoms (p < 0.001), weakness (p < 0.001), anxiety (p < 0.001), and tiredness (p < 0.001).
Using the established MIDOS2 cut-off value with an adjusted double weighting in our study, a large proportion of inpatients may be accurately referred to SPC based on their subjective need for palliative support. Additionally, subjective reports of poor general, mental, and physical condition, as well as pain, depressive symptoms, weakness, anxiety, and tiredness, increase the subjective need for palliative support, particularly in patients with a survival prognosis of less than one year.
推荐使用最小文档系统（MIDOS2）作为一种系统筛查工具，用于评估晚期癌症患者的症状负担和患者需求。鉴于缺乏对个体症状的最佳加权以及相应的临界值，本研究旨在根据住院患者对姑息治疗支持的主观需求确定一个阈值。此外，我们通过患者报告结局量表（PROM）收集的症状负担与对姑息治疗支持的主观需求之间的相关性，以及患者的生存时间（少于或多于一年）进行了研究。
诊断为晚期实体癌的住院患者完成了一份电子PROM，其中包括MIDOS2问卷以及其他工具。使用方差分析、曼-惠特尼-U检验、逻辑回归、Pearson和Spearman相关性检验，分析了表达对姑息治疗支持主观需求的患者与生存时间少于或多于一年的患者之间的症状负担差异。使用ROC曲线进行临界值分析。还使用了约登指数、敏感性和特异性测量方法。
在2020年4月至2021年3月期间，265名住院患者纳入了本研究。通过ROC曲线分析，MIDOS2在评估对姑息治疗支持的主观需求时，曲线下面积（AUC）为0.732，相应的临界值为8分，敏感性为76.36%，特异性为62.98%。对显著症状进行双重加权的MIDOS2显示临界值为14分，敏感性为78.18%，特异性为72.38%。共有55名患者（20.8%）表示需要姑息治疗团队的支持。这种需求与肿瘤实体无关，且在生存时间少于一年的患者中有所增加。这些患者报告的身体（p < 0.001）或精神（p < 0.001）状况明显较差。此外，他们报告的疼痛（p = 0.002）、抑郁症状（p < 0.001）、虚弱（p < 0.001）、焦虑（p < 0.001）和疲劳（p < 0.001）强度更高。
在我们的研究中，使用经过调整的双重加权的既定MIDOS2临界值，很大一部分住院患者可根据其对姑息治疗支持的主观需求被准确转诊至专科姑息治疗。此外，总体、精神和身体状况差的主观报告，以及疼痛、抑郁症状、虚弱、焦虑和疲劳，会增加对姑息治疗支持的主观需求，特别是在生存预后少于一年的患者中。
