The Impact of Baseline Edmonton Symptom Assessment Scale Scores on Treatment and Survival in Patients With Advanced Non-small-cell Lung Cancer

Sharon F. McGee, Tinghua Zhang, Hannah Jonker, Scott A. Laurie, Glen Goss, Garth Nicholas, Khalid Albaimani, Paul Wheatley-Price

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Palliative systemic therapy is frequently underutilized in patients with advanced non-small-cell lung cancer (NSCLC), for many reasons. The aim of this study was to identify patient-reported factors that may predict for treatment decisions and survival in advanced NSCLC, using the Edmonton Symptom Assessment Scale (ESAS), which is a self-reported questionnaire that quantifies symptom burden by asking patients to rate the severity of 9 common symptoms. Patients and Methods: With ethics approval, we analyzed ESAS scores at initial oncology consultation for 461 patients with advanced NSCLC seen at The Ottawa Hospital Cancer Centre from 2009 to 2012. Subgroup analysis was performed to determine if treatment strategies or overall survival (OS) were related to the total symptom burden, as defined by the sum of the individual ESAS symptom scores. Results: The severity of the ESAS total symptom burden score was positively correlated with Eastern Cooperative Oncology Group performance status (R = 0.48; P < .0001). Furthermore, patients with a higher symptom burden were less likely to receive systemic chemotherapy than those with fewer symptoms (43% vs. 66%; P < .0001), and had a significantly reduced OS (5.5 vs. 9.9 months; P < .0001). A higher ESAS symptom burden score was also associated with reduced OS by univariate analysis (hazard ratio, 1.78; 95% confidence interval, 1.45-2.18; P < .0001), although multivariate analysis showed only a trend towards significance (hazard ratio, 1.27; 95% confidence interval, 0.99-1.62; P = .06). Conclusions: Overall, this demonstrates a novel role for the ESAS as a prognostic tool that could complement existing patient assessment models, such as Eastern Cooperative Oncology Group performance status, in the development of optimal treatment plans and estimation of survival, in patients with advanced lung cancer.

Original languageEnglish
JournalClinical Lung Cancer
DOIs
Publication statusAccepted/In press - 2017

Fingerprint

Symptom Assessment
Non-Small Cell Lung Carcinoma
Survival
Therapeutics
Confidence Intervals
Cancer Care Facilities
Survival Analysis
Palliative Care
Ethics
Lung Neoplasms
Referral and Consultation
Multivariate Analysis
Drug Therapy

Keywords

  • NSCLC
  • Overall survival
  • Performance status
  • Symptom burden
  • Systemic chemotherapy

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine
  • Cancer Research

Cite this

The Impact of Baseline Edmonton Symptom Assessment Scale Scores on Treatment and Survival in Patients With Advanced Non-small-cell Lung Cancer. / McGee, Sharon F.; Zhang, Tinghua; Jonker, Hannah; Laurie, Scott A.; Goss, Glen; Nicholas, Garth; Albaimani, Khalid; Wheatley-Price, Paul.

In: Clinical Lung Cancer, 2017.

Research output: Contribution to journalArticle

McGee, Sharon F. ; Zhang, Tinghua ; Jonker, Hannah ; Laurie, Scott A. ; Goss, Glen ; Nicholas, Garth ; Albaimani, Khalid ; Wheatley-Price, Paul. / The Impact of Baseline Edmonton Symptom Assessment Scale Scores on Treatment and Survival in Patients With Advanced Non-small-cell Lung Cancer. In: Clinical Lung Cancer. 2017.
@article{da413898ab324d04839838cf07c71b46,
title = "The Impact of Baseline Edmonton Symptom Assessment Scale Scores on Treatment and Survival in Patients With Advanced Non-small-cell Lung Cancer",
abstract = "Background: Palliative systemic therapy is frequently underutilized in patients with advanced non-small-cell lung cancer (NSCLC), for many reasons. The aim of this study was to identify patient-reported factors that may predict for treatment decisions and survival in advanced NSCLC, using the Edmonton Symptom Assessment Scale (ESAS), which is a self-reported questionnaire that quantifies symptom burden by asking patients to rate the severity of 9 common symptoms. Patients and Methods: With ethics approval, we analyzed ESAS scores at initial oncology consultation for 461 patients with advanced NSCLC seen at The Ottawa Hospital Cancer Centre from 2009 to 2012. Subgroup analysis was performed to determine if treatment strategies or overall survival (OS) were related to the total symptom burden, as defined by the sum of the individual ESAS symptom scores. Results: The severity of the ESAS total symptom burden score was positively correlated with Eastern Cooperative Oncology Group performance status (R = 0.48; P < .0001). Furthermore, patients with a higher symptom burden were less likely to receive systemic chemotherapy than those with fewer symptoms (43{\%} vs. 66{\%}; P < .0001), and had a significantly reduced OS (5.5 vs. 9.9 months; P < .0001). A higher ESAS symptom burden score was also associated with reduced OS by univariate analysis (hazard ratio, 1.78; 95{\%} confidence interval, 1.45-2.18; P < .0001), although multivariate analysis showed only a trend towards significance (hazard ratio, 1.27; 95{\%} confidence interval, 0.99-1.62; P = .06). Conclusions: Overall, this demonstrates a novel role for the ESAS as a prognostic tool that could complement existing patient assessment models, such as Eastern Cooperative Oncology Group performance status, in the development of optimal treatment plans and estimation of survival, in patients with advanced lung cancer.",
keywords = "NSCLC, Overall survival, Performance status, Symptom burden, Systemic chemotherapy",
author = "McGee, {Sharon F.} and Tinghua Zhang and Hannah Jonker and Laurie, {Scott A.} and Glen Goss and Garth Nicholas and Khalid Albaimani and Paul Wheatley-Price",
year = "2017",
doi = "10.1016/j.cllc.2017.05.018",
language = "English",
journal = "Clinical Lung Cancer",
issn = "1525-7304",
publisher = "Elsevier",

}

TY - JOUR

T1 - The Impact of Baseline Edmonton Symptom Assessment Scale Scores on Treatment and Survival in Patients With Advanced Non-small-cell Lung Cancer

AU - McGee, Sharon F.

AU - Zhang, Tinghua

AU - Jonker, Hannah

AU - Laurie, Scott A.

AU - Goss, Glen

AU - Nicholas, Garth

AU - Albaimani, Khalid

AU - Wheatley-Price, Paul

PY - 2017

Y1 - 2017

N2 - Background: Palliative systemic therapy is frequently underutilized in patients with advanced non-small-cell lung cancer (NSCLC), for many reasons. The aim of this study was to identify patient-reported factors that may predict for treatment decisions and survival in advanced NSCLC, using the Edmonton Symptom Assessment Scale (ESAS), which is a self-reported questionnaire that quantifies symptom burden by asking patients to rate the severity of 9 common symptoms. Patients and Methods: With ethics approval, we analyzed ESAS scores at initial oncology consultation for 461 patients with advanced NSCLC seen at The Ottawa Hospital Cancer Centre from 2009 to 2012. Subgroup analysis was performed to determine if treatment strategies or overall survival (OS) were related to the total symptom burden, as defined by the sum of the individual ESAS symptom scores. Results: The severity of the ESAS total symptom burden score was positively correlated with Eastern Cooperative Oncology Group performance status (R = 0.48; P < .0001). Furthermore, patients with a higher symptom burden were less likely to receive systemic chemotherapy than those with fewer symptoms (43% vs. 66%; P < .0001), and had a significantly reduced OS (5.5 vs. 9.9 months; P < .0001). A higher ESAS symptom burden score was also associated with reduced OS by univariate analysis (hazard ratio, 1.78; 95% confidence interval, 1.45-2.18; P < .0001), although multivariate analysis showed only a trend towards significance (hazard ratio, 1.27; 95% confidence interval, 0.99-1.62; P = .06). Conclusions: Overall, this demonstrates a novel role for the ESAS as a prognostic tool that could complement existing patient assessment models, such as Eastern Cooperative Oncology Group performance status, in the development of optimal treatment plans and estimation of survival, in patients with advanced lung cancer.

AB - Background: Palliative systemic therapy is frequently underutilized in patients with advanced non-small-cell lung cancer (NSCLC), for many reasons. The aim of this study was to identify patient-reported factors that may predict for treatment decisions and survival in advanced NSCLC, using the Edmonton Symptom Assessment Scale (ESAS), which is a self-reported questionnaire that quantifies symptom burden by asking patients to rate the severity of 9 common symptoms. Patients and Methods: With ethics approval, we analyzed ESAS scores at initial oncology consultation for 461 patients with advanced NSCLC seen at The Ottawa Hospital Cancer Centre from 2009 to 2012. Subgroup analysis was performed to determine if treatment strategies or overall survival (OS) were related to the total symptom burden, as defined by the sum of the individual ESAS symptom scores. Results: The severity of the ESAS total symptom burden score was positively correlated with Eastern Cooperative Oncology Group performance status (R = 0.48; P < .0001). Furthermore, patients with a higher symptom burden were less likely to receive systemic chemotherapy than those with fewer symptoms (43% vs. 66%; P < .0001), and had a significantly reduced OS (5.5 vs. 9.9 months; P < .0001). A higher ESAS symptom burden score was also associated with reduced OS by univariate analysis (hazard ratio, 1.78; 95% confidence interval, 1.45-2.18; P < .0001), although multivariate analysis showed only a trend towards significance (hazard ratio, 1.27; 95% confidence interval, 0.99-1.62; P = .06). Conclusions: Overall, this demonstrates a novel role for the ESAS as a prognostic tool that could complement existing patient assessment models, such as Eastern Cooperative Oncology Group performance status, in the development of optimal treatment plans and estimation of survival, in patients with advanced lung cancer.

KW - NSCLC

KW - Overall survival

KW - Performance status

KW - Symptom burden

KW - Systemic chemotherapy

UR - http://www.scopus.com/inward/record.url?scp=85021816370&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85021816370&partnerID=8YFLogxK

U2 - 10.1016/j.cllc.2017.05.018

DO - 10.1016/j.cllc.2017.05.018

M3 - Article

JO - Clinical Lung Cancer

JF - Clinical Lung Cancer

SN - 1525-7304

ER -