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Abstract
Context
Symptom
changes are usually reported using summary statistics such as mean
and/or median, which may obscure the treatment effect.
Objectives
The
main objective of this retrospective study was to determine the
magnitude of symptom changes as assessed by the Edmonton Symptom
Assessment System (ESAS) after outpatient palliative care at the first
follow-up visit.
Methods
We
reviewed 1612 consecutive patients with cancer who were referred to the
outpatient Supportive Care Center and who completed the ESAS at the
initial and first follow-up visits between January 2003 and December
2010. All patients received interdisciplinary care led by the palliative
care specialists following an institutional protocol.
Results
The
distribution of the magnitude of symptom changes was stratified by
baseline intensities. Patterns were similar for different ESAS items. At
the follow-up visit (median: 15 days later), 52–74% of patients showed a
decrease of one or more points in the ESAS score. However, 48–80% of
the patients with moderate/severe intensity at baseline complained of
symptoms with an ESAS score of four or more after outpatient palliative
care. Symptoms with absent/mild intensity worsened, ranging from a mean
of −3.04 to 0.12 at the first follow-up visit, whereas symptoms with
moderate/severe intensity improved from −0.2 to 3.86 (P < 0.001).
Conclusion
A
considerable proportion of patients with moderate or severe intensity
at baseline still had symptoms with an ESAS score of four or more.
Patients with absent/mild intensities at baseline complained of symptom
exacerbation at the first follow-up visit. Various strategies are needed
to optimize symptom control in advanced cancer.
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