Testing Symptom Severity Thresholds and Potential Alerts for Clinical Intervention in Patients With Cancer Undergoing Chemotherapy.
| Autor: | Qiuling Shi, Ju-Whei Lee, Xin Shelley Wang, Fisch, Michael J., Chang, Victor T., Wagner, Lynne, Cleeland, Charles S. |
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| Předmět: |
CANCER chemotherapy
CANCER patients CANCER patient medical care CHI-squared test COMPARATIVE studies CONFIDENCE intervals DRUGS DRUG toxicity LONGITUDINAL method MEDICAL cooperation PATIENT compliance PATIENT monitoring QUESTIONNAIRES RESEARCH SURVIVAL TUMORS LOGISTIC regression analysis TREATMENT effectiveness HUMAN services programs SEVERITY of illness index DATA analysis software DESCRIPTIVE statistics |
| Zdroj: | JCO Oncology Practice; Sep2020, Vol. 16 Issue 9, pe893-e901, 8p |
| Abstrakt: | PURPOSE Symptom monitoring is attracting attention as a way to improve adherence to cancer therapy, reduce treatment-related toxicities, and possibly improve overall survival. How reporting thresholds affect symptom alert generation and clinical outcomes is poorly understood. PATIENTS AND METHODS We analyzed data from 38 US health care institutions collected for the prospective Eastern Cooperative Oncology Group–American College of Radiology Imaging Network E2Z02 Symptom Outcomes and Practice Patterns study. Participants were outpatients receiving chemotherapy for breast (n = 642), colorectal (n = 486), or lung cancer (n = 340) who rated symptom severity using the MD Anderson Symptom Inventory at 2 assessment points 1 month apart. Percentages of patients with pain, dyspnea, fatigue, or distress at different thresholds (score of 4-7 on a 0-10 scale) were compared. The percentage of patients whose performance status had worsened at follow-up was used to estimate risk for missing clinically important symptom data by using higher severity thresholds RESULTS At the guideline-recommended threshold of ≥ 4, suprathreshold rates were 60% for any of the 4 symptoms at the initial survey; performance status worsened at follow-up for 27% of all patients with any symptom rated ≥ 4 at the initiate survey. When the threshold was increased to ≥ 7, approximately half of patients (51%) with worsened performance status were not identified. CONCLUSION The burden to clinicians from an alert threshold of ≥ 4 (per many current guidelines) would be substantial. However, setting higher alert thresholds may miss a large percentage of patients who need clinical intervention. These results may inform resource planning when implementing electronic symptom screening at an institutional or practice level. [ABSTRACT FROM AUTHOR] |
| Databáze: | Complementary Index |
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