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Use of Symptom Assessment Scale vs Routine Management in Patients With Cancer Receiving Radiotherapy


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In a single-institution study reported in JCO Oncology Practice, Goyal et al found that use of the Edmonton Symptom Assessment Scale (ESAS) self-assessment tool during weekly on-treatment physician visits was associated with reduced symptom severity vs routine symptom management in patients receiving radiotherapy for cancer.

“Incorporation of ESAS for [on-treatment visits] was associated with stable or improved symptom severity where therapeutic intervention is more readily available, such as counseling, pain medication, antiemetics, appetite stimulants, and antianxiolytics. The incorporation of validated patient-reported symptom-scoring tools may improve provider management.”
— Goyal et al

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Study Details

In the study, 85 patients in a preintervention group completed the ESAS on a weekly basis, with their provider being blinded to ESAS information and providing routine symptom management. A postintervention group of 170 patients completed the ESAS weekly, with results reviewed by their provider and incorporated into the weekly visit. Symptom domains in the nine-item ESAS consist of pain, tiredness, depression, anxiety, drowsiness, appetite, overall feeling of well-being, shortness of breath, and any other problems experienced. Patients were surveyed for an average of 4.7 weeks.

Key Findings

Compared with the preintervention group, stable or improved symptom severity was observed in the postintervention group for pain (85.6% vs 70.7%, P = .005) and anxiety (92.9% vs 79.3%, P = .002).

On multivariate analysis—including adjustment for concurrent systemic therapy, treatment site, radiotherapy intent, number of survey weeks, sex, and Karnofsky performance status—the postintervention group was significantly less likely to report worsening severity of pain (odds ratio [OR] = 0.13, P < .001), nausea (OR = 0.25, P = .023), loss of appetite (OR = 0.30, P = .024), and anxiety (OR = 0.19, P = .005).

Overall, 87.5% of physicians and 75.0% of nurses reported finding ESAS review useful in symptom management.

The investigators concluded, “Incorporation of ESAS for [on-treatment visits] was associated with stable or improved symptom severity where therapeutic intervention is more readily available, such as counseling, pain medication, antiemetics, appetite stimulants, and antianxiolytics. The incorporation of validated patient-reported symptom-scoring tools may improve provider management.”

Uma D. Goyal, MD, of the Department of Radiation Oncology, University of Arizona, Tucson, is the corresponding author for the JCO Oncology Practice article. 

Disclosure: For full disclosures of the study authors, visit ascopubs.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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