scholarly journals The impact of routine Edmonton Symptom Assessment System (ESAS) use on overall survival in cancer patients: Results of a population‐based retrospective matched cohort analysis

2020 ◽  
Vol 9 (19) ◽  
pp. 7107-7115
Author(s):  
Lisa Barbera ◽  
Rinku Sutradhar ◽  
Hsien Seow ◽  
Nicole Mittmann ◽  
Doris Howell ◽  
...  
Keyword(s):  
Overall Survival ◽  
Cancer Patients ◽  
Cohort Analysis ◽  
Symptom Assessment ◽  
Population Based ◽  
Assessment System ◽  
Matched Cohort ◽  
Edmonton Symptom Assessment System ◽  
The Impact

The impact of routine ESAS use on overall survival: Results of a population-based retrospective matched cohort analysis.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6509-6509 ◽  
Author(s):  
Lisa Catherine Barbera ◽  
Rinku Sutradhar ◽  
Craig Earle ◽  
Nicole Mittmann ◽  
Hsien Seow ◽  
...  
Keyword(s):  
Overall Survival ◽  
Cancer Patients ◽  
Cox Regression ◽  
Cohort Analysis ◽  
Symptom Assessment ◽  
Assessment System ◽  
Cancer Type ◽  
Matched Cohort ◽  
Study Objective ◽  
The Impact

6509 Background: The study objective was to examine the impact of routine Edmonton Symptom Assessment System (ESAS) use on overall survival among adult cancer patients. We hypothesized that patients exposed to ESAS would have better overall survival rates than those who didn’t have ESAS. Methods: The effect of ESAS screening on survival was evaluated in a retrospective matched cohort study. The cohort included all Ontario patients aged 18 or older who were diagnosed with cancer between 2007 and 2015. Patients completing at least one ESAS assessment during the study were considered exposed. The index date was the day of their first ESAS assessment. Follow up time for each patient was segmented into one of three phases: initial, continuing, or palliative care. Exposed and unexposed patients were matched 1:1 using hard (birth year ± 2 years, cancer diagnosis date ± 1 year, cancer type and sex) and propensity-score matching (14 measures including cancer stage, treatments received, and comorbidity). Matched patients were followed until death or the end of study at Dec 31, 2015. Kaplan-Meier curves and multivariable Cox regression were used to evaluate the impact of ESAS on survival. Results: There were 128,893 pairs well matched on all baseline characteristics (standardized difference < 0.1). The probability of survival within the first 5 years was higher among those exposed to ESAS compared to those who were not (73.8% vs. 72.0%, P-value < 0.0001). In the multivariable Cox regression model, ESAS assessment was significantly associated with a decreased mortality risk (HR: 0.49, 95% CI: 0.48-0.49) and this protective effect was seen across all phases. Conclusions: ESAS exposure is associated with improved survival in cancer patients, in all phases of care. To the extent possible, extensive matching methods have mitigated biases inherent to observational data. This provides real world evidence of the impact of routine symptom assessment in cancer care.

The impact of routine Edmonton symptom assessment system use on receiving palliative care services: results of a population-based retrospective-matched cohort analysis

2020 ◽  
pp. bmjspcare-2020-002220
Author(s):  
Lisa Barbera ◽  
Rinku Sutradhar ◽  
Craig C Earle ◽  
Doris Howell ◽  
Nicole Mittman ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cohort Analysis ◽  
Symptom Assessment ◽  
Assessment System ◽  
Matched Cohort ◽  
Edmonton Symptom Assessment System ◽  
Care Services ◽  
Patient Reported ◽  
Palliative Care Services ◽  
The Impact

BackgroundIn 2007, Cancer Care Ontario began standardised symptom assessment as part of routine care using the Edmonton Symptom Assessment System (ESAS).AimThe purpose of this study was to evaluate the impact of ESAS on receipt of palliative care when compared with a matched group of unexposed patients.DesignA retrospective-matched cohort study examined the impact of ESAS screening on initiation of palliative care services provided by physicians or homecare nurses. The study included adult patients diagnosed with cancer between 2007 and 2015. Exposure was defined as completing ≥1 ESAS during the study period. Using 4 hard and 14 propensity score-matched variables, patients with cancer exposed to ESAS were matched 1:1 to those who were not. Matched patients were followed from first ESAS until initiation of palliative care, death or end of study.ResultsThe final cohort consisted of 204 688 matched patients with no prior palliative care consult. The pairs were well matched. The cumulative incidence of receiving palliative care within the first 5 years was higher among those exposed to ESAS compared with those who were not (27.9% (95% CI: 27.5% to 28.2%) versus 27.9% (95% CI: 27.5% to 28.2%)), when death is considered as a competing event. In the adjusted cause-specific Cox proportional hazards model, ESAS assessment was associated with a 6% increase in palliative care services (HR: 1.06, 95% CI: 1.04 to 1.08).ConclusionWe have demonstrated that patients exposed to ESAS were more likely to receive palliative care services compared with patients who were not exposed. This observation provides real-world data of the impact of routine assessment with a patient-reported outcome.

The impact of routine ESAS use on receiving palliative care services: Results of a population-based retrospective matched cohort analysis.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 191-191 ◽  
Author(s):  
Lisa Catherine Barbera ◽  
Rinku Sutradhar ◽  
Craig Earle ◽  
Nicole Mittmann ◽  
Hsien Seow ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Clinical Care ◽  
Symptom Assessment ◽  
Assessment System ◽  
Matched Cohort ◽  
Risk Of Death ◽  
Care Services ◽  
Palliative Care Services ◽  
The Impact

191 Background: In 2007 Cancer Care Ontario began standardized symptom assessment as part of routine clinical care using the Edmonton Symptom Assessment System (ESAS). The purpose of this project was to evaluate the impact of this program on referrals to palliative care. We hypothesized that patients exposed to ESAS would be more likely to be referred. Methods: A retrospective matched cohort study was conducted to examine the impact of ESAS screening on the initiation of palliative care services provided by physician or homecare nurse among newly diagnosed cancer patients in Ontario, Canada. The study included all adult patients who were diagnosed with cancer between 2007 and 2015. Exposure was defined as completing ≥1 ESAS during the study period. Using four hard matched variables and propensity-score matching with 14 variables, cancer patients exposed to ESAS were matched 1:1 to those who were not. Matched patients were followed from first ESAS until initiation of palliative care, death or the end of study at Mar 31, 2017. Results: The final cohort consisted of 204,688 matched patients with no prior palliative care consult. The pairs were well matched. The probability of receiving palliative care within the first 5 years was higher among those exposed to ESAS compared to those who were not (20.6% vs. 15.2%, p < .0001). The risk of death without receipt of palliative care within the same period was low in both groups. In the adjusted cause-specific Cox proportional hazards model, ESAS assessment was associated with a 6% increase in palliative care services (HR: 1.06, 95% CI: 1.04-1.08). Conclusions: Cancer patients who completed ESAS were more likely to initiate palliative care services than those who didn’t. ESAS screening may help identify patients who would benefit from a palliative approach to care earlier in their clinical course.

Impact of Standardized Edmonton Symptom Assessment System Use on Emergency Department Visits and Hospitalization: Results of a Population-Based Retrospective Matched Cohort Analysis

2020 ◽  
Vol 16 (9) ◽  
pp. e958-e965 ◽  
Author(s):  
Lisa Barbera ◽  
Rinku Sutradhar ◽  
Hsien Seow ◽  
Craig C. Earle ◽  
Doris Howell ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Analysis ◽  
Symptom Assessment ◽  
Emergency Department Visits ◽  
Assessment System ◽  
Recurrent Event ◽  
Cancer Type ◽  
Matched Cohort ◽  
Edmonton Symptom Assessment System ◽  
Ed Visits

PURPOSE: The Edmonton Symptom Assessment System (ESAS) is a validated instrument whose use has been standardized in the Ontario cancer system to measure symptoms among ambulatory patients with cancer. The objective was to examine the effect of ESAS exposure on visits to the emergency department (ED) and hospitalizations. METHODS: This was a retrospective matched cohort study conducted in Ontario, Canada. The study included patients ≥ 18 years of age diagnosed with cancer between 2007 and 2015. Patients were considered exposed if they were screened with ESAS at least once during the study period, and their first ESAS screening date was defined as the index date. Each exposed patient was matched randomly to a patient with cancer without ESAS assessment using a combination of hard matching (birth year ± 2 years, cancer diagnosis date ± 1 year, cancer type, and sex) and propensity score matching (14 variables, including cancer stage, treatments received, and comorbidities). A multivariable Andersen-Gill recurrent event model was used to evaluate the effect of ESAS on the rate of health care use. RESULTS: The analysis included 128,893 matched pairs that were well balanced on baseline measures. After adjusting for other variables, patients with ESAS had lower rates of both ED visits (relative rate [RR], 0.92; 95% CI, 0.91 to 0.93) and hospitalizations (RR, 0.86; 95% CI, 0.85 to 0.87) compared with patients without ESAS. CONCLUSION: ESAS exposure is independently associated with decreased rates of ED visits and hospitalizations. This provides real-world evidence of one potential positive impact of standardized symptom assessment in cancer care.

Utility of the revised Edmonton Symptom Assessment System (ESAS-r) and the Patient-Reported Functional Status (PRFS) in lung cancer patients

2017 ◽  
Vol 26 (3) ◽  
pp. 767-775 ◽  
Author(s):  
M. N. Yogananda ◽  
Valliappan Muthu ◽  
Kuruswamy Thurai Prasad ◽  
Adarsh Kohli ◽  
Digambar Behera ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Functional Status ◽  
Cancer Patients ◽  
Symptom Assessment ◽  
Assessment System ◽  
Edmonton Symptom Assessment System ◽  
Lung Cancer Patients ◽  
Patient Reported

scholarly journals Longitudinal Changes of Cytokines and Appetite in Older Hospitalized Patients

Nutrients ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 2508
Author(s):  
Maryam Pourhassan ◽  
Nina Babel ◽  
Lars Sieske ◽  
Timm Henning Westhoff ◽  
Rainer Wirth
Keyword(s):  
Symptom Assessment ◽  
Serum Levels ◽  
Hospitalized Patients ◽  
Assessment System ◽  
Edmonton Symptom Assessment System ◽  
Tnf Α ◽  
Longitudinal Association ◽  
Few Data ◽  
Prospective Longitudinal ◽  
The Impact

There are few data on the longitudinal association of cytokine and appetite among older hospitalized patients. We aimed to investigate the impact of the changes of inflammatory cytokines on appetite in older hospitalized patients. A total of 191 patients (mean age 81.3 ± 6.6 years, 64% women) participated in this prospective longitudinal observational study. Appetite was evaluated using the Edmonton Symptom Assessment System on admission and after seven days. Serum cytokines such as IL-1β, IL-6, IL-8, IL-10, IL-12p70, IL-17, IL-18, IL-23 and IL-33, IFN-α2, IFN-γ, TNF-α and MCP-1 were measured both times. No significant differences in the mean serum levels of all the cytokines could be detected overtime in relation to appetite changes, except for IL-18. Appetite significantly deteriorated overtime in patients with increasing IL-18 levels and improved in those without significant changes in IL-18 levels. In a stepwise regression analysis, changes of IL-18 levels were the major independent predictor for the changes of patients’ appetite and explained 4% of the variance, whereas other cytokines and variables, such as age, sex, infection and disease, did not show any impact on appetite changes. We conclude that IL-18 seems to exert a significant impact on appetite in acutely ill older hospitalized patients and should, therefore, be considered as a potential target in the diagnosis, prevention and treatment of malnutrition.

scholarly journals Association of Edmonton Symptom Assessment System Global Distress Score With Overall Survival in Patients With Advanced Cancer

2021 ◽  
Vol 4 (7) ◽  
pp. e2117295
Author(s):  
Ishwaria M. Subbiah ◽  
Maira M. Charone ◽  
Jason Roszik ◽  
Ali Haider ◽  
Marieberta Vidal ◽  
...  
Keyword(s):  
Overall Survival ◽  
Advanced Cancer ◽  
Symptom Assessment ◽  
Assessment System ◽  
Edmonton Symptom Assessment System ◽  
Distress Score ◽  
Global Distress
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