Pranajaya Philip, Ho Vincent, Jiang Mengzhu, Tran Vance, Sinnarajah Aynharan
Faculty of Health Sciences, Queen's University, Kingston, ON K7L 3N6, Canada.
Division of Palliative Medicine, Department of Medicine, Lakeridge Health, Oshawa, ON L1G 2B9, Canada.
Curr Oncol. 2025 Jul 4;32(7):388. doi: 10.3390/curroncol32070388.
Among adult advanced cancer patients already accessing palliative care, symptoms can contribute to unplanned acute care utilizations, which can disrupt care and worsen patient outcomes. We examined how a novel symptom complexity algorithm, using patients' ratings of the nine Edmonton Symptom Assessment System-Revised (ESAS-r) symptoms to assign "low", "medium", or "high" complexity, predicts acute care utilizations. This retrospective observational cohort study used electronic medical record data from the Durham Regional Cancer Centre in Ontario, Canada, comprising adult advanced cancer patients who completed at least one ESAS-r report between 1 January 2022 and 31 December 2023. We applied chi-squared tests, Kruskal-Wallis H tests, and multivariable binary logistic regressions to evaluate factors associated with higher odds of acute care utilization within seven and fourteen days of patients' first ESAS-r reports after their first palliative care interaction. Of 559 included patients, 125 (22.4%) exhibited low complexity, 180 (32.2%) exhibited medium complexity, and 254 (45.4%) exhibited high complexity on their first ESAS-r report. In total, 61 (10.9%) patients accessed acute care within seven days and 108 (19.3%) patients accessed acute care within fourteen days of their first ESAS-r report. Controlling for sociodemographic and clinical covariates, compared to low-complexity patients, high-complexity patients had higher odds of acute care utilization within seven days (aOR = 2.83, 95% CI: 1.18-6.77), but not within fourteen days (aOR = 1.78, 95% CI: 0.97-3.28). Accordingly, as a clinical decision-making tool, ESAS-r symptom complexity may help identify patients who would benefit from more intensive follow-up and potentially reduce unnecessary acute care utilizations.
在已经接受姑息治疗的成年晚期癌症患者中，症状可能导致非计划的急性护理使用，这可能会扰乱护理并使患者预后恶化。我们研究了一种新颖的症状复杂性算法，该算法使用患者对埃德蒙顿症状评估系统修订版（ESAS-r）的九种症状的评分来划分“低”、“中”或“高”复杂性，以预测急性护理的使用情况。这项回顾性观察队列研究使用了加拿大安大略省达勒姆地区癌症中心的电子病历数据，研究对象为2022年1月1日至2023年12月31日期间完成至少一份ESAS-r报告的成年晚期癌症患者。我们应用卡方检验、Kruskal-Wallis H检验和多变量二元逻辑回归来评估与患者首次接受姑息治疗后首次ESAS-r报告的7天和14天内急性护理使用几率较高相关的因素。在纳入的559名患者中，125名（22.4%）在首次ESAS-r报告时表现为低复杂性，180名（32.2%）表现为中等复杂性，254名（45.4%）表现为高复杂性。总共有61名（10.9%）患者在首次ESAS-r报告后的7天内接受了急性护理，108名（19.3%）患者在14天内接受了急性护理。在控制了社会人口统计学和临床协变量后，与低复杂性患者相比，高复杂性患者在7天内接受急性护理的几率更高（调整后比值比[aOR]=2.83，95%置信区间[CI]：1.18-6.77），但在14天内则不然（aOR=1.78，95%CI：0.97-3.28）。因此，作为一种临床决策工具，ESAS-r症状复杂性可能有助于识别那些将从更密集的随访中受益的患者，并有可能减少不必要的急性护理使用。
