scholarly journals Has Province-Wide Symptom Screening Changed Opioid Prescribing Rates in Older Patients With Cancer?

2017 ◽  
Vol 13 (11) ◽  
pp. e927-e934 ◽  
Author(s):  
Lisa Barbera ◽  
Rinku Sutradhar ◽  
Anna Chu ◽  
Hsien Seow ◽  
Craig C. Earle ◽  
...  
Keyword(s):  
Pain Assessment ◽  
Index Date ◽  
Symptom Assessment ◽  
Assessment System ◽  
Opioid Prescription ◽  
Edmonton Symptom Assessment System ◽  
Opioid Prescribing ◽  
Patients With Cancer ◽  
Symptom Screening ◽  
Prescription Rates

Purpose: Previous work in Ontario demonstrated that 33% of patients with cancer with severe pain did not receive opioids at the time of their pain assessment. With efforts to increase symptom screening and management since then, the objective of this study was to examine temporal trends in opioid prescribing. Methods: The cohort was comprised of Ontario residents ≥ 65 years of age with a cancer history who were eligible for the government pharmacare program and had a pain assessment using the Edmonton Symptom Assessment System. Use of the Edmonton Symptom Assessment System is part of a provincial initiative to screen ambulatory patients with cancer for symptoms. Annually between 2007 and 2013, we used the date of an individual’s highest pain score as the index date to calculate annual opioid prescription rates for claims within 30 days before and up to 7 days after the index date. A logistic regression model evaluated the association between index year and odds of receiving an opioid prescription. Results: During the study period, the number of individuals undergoing symptom assessment annually increased more than eight-fold. Opioid prescription rates were directly related to pain scores, but there was an annual 5% relative decrease in the odds of receiving an opioid prescription during the era from 2009 to 2013. Conclusion: We are doing better at screening for pain, but this has not led to an increase in analgesic intervention for those identified. Additional work is required to determine what opioid prescribing rate is optimal to ensure we are not missing opportunities to improve patient comfort.

scholarly journals Dyspnea is associated with overall symptom burden in patients with chronic respiratory insufficiency

2020 ◽  
Author(s):  
Heidi Anniina Rantala ◽  
Sirpa Leivo-Korpela ◽  
Juho T. Lehto ◽  
Lauri Lehtimäki
Keyword(s):  
Respiratory Insufficiency ◽  
Depression Scale ◽  
Symptom Burden ◽  
Symptom Assessment ◽  
Assessment System ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Edmonton Symptom Assessment System ◽  
Symptom Screening ◽  
Chronic Respiratory Insufficiency

Abstract Objective Patients with chronic respiratory insufficiency suffer from many symptoms together with dyspnea. We evaluated the association of dyspnea with other symptoms in patients with chronic respiratory insufficiency due to chronic obstructive pulmonary disease or interstitial lung disease. Results This retrospective study included 101 patients. Dyspnea was assessed with modified Medical Research Council dyspnea questionnaire (mMRC) and other symptoms with Edmonton Symptom Assessment System (ESAS) and Depression Scale (DEPS). Patients with mMRC 4 (most severe dyspnea) compared to those with mMRC 0–3 reported higher median (IQR) symptom scores on ESAS in e.g. dry mouth (7.0 (4.0–8.0) vs. 3.0 (1.0–6.0), P < 0.001), tiredness (6.0 (3.0–7.0) vs. 3.0 (1.0–5.0), P < 0.001) and anxiety (3.0 (0.0-5.5) vs. 1.0 (0.0–3.0), P = 0.007). Patients with mMRC 4 were more likely to reach the DEPS threshold for depression compared to those with mMRC 0–3 (42.1% vs. 20.8%, P = 0.028). In conclusion, patients with chronic respiratory insufficiency need comprehensive symptom screening with relevant treatment, as they suffer from many severe symptoms worsening with increased dyspnea.

scholarly journals Implementing a Patient-Reported Outcome Measure for Hemodialysis Patients in Routine Clinical Care

2020 ◽  
Vol 15 (9) ◽  
pp. 1299-1309 ◽  
Author(s):  
Jenna M. Evans ◽  
Alysha Glazer ◽  
Rebecca Lum ◽  
Esti Heale ◽  
Marnie MacKinnon ◽  
...  
Keyword(s):  
Outcome Measure ◽  
Symptom Burden ◽  
Symptom Assessment ◽  
Patient Reported Outcome ◽  
Assessment System ◽  
Edmonton Symptom Assessment System ◽  
Patient Reported Outcome Measure ◽  
Symptom Screening ◽  
Patient Reported ◽  
Patient Provider Communication

Background and objectivesThe Edmonton Symptom Assessment System Revised: Renal is a patient-reported outcome measure used to assess physical and psychosocial symptom burden in patients treated with maintenance dialysis. Studies of patient-reported outcome measures suggest the need for deeper understanding of how to optimize their implementation and use. This study examines patient and provider perspectives of the implementation process and the influence of the Edmonton Symptom Assessment System Revised: Renal on symptom management, patient-provider communication, and interdisciplinary communication.Design, setting, participants, & measurements Eight in-facility hemodialysis programs in Ontario, Canada, assessed patients using the Edmonton Symptom Assessment System Revised: Renal every 4–6 weeks for 1 year. Screening and completion rates were tracked, and pre- and postimplementation surveys and midimplementation interviews were conducted with patients and providers. A chart audit was conducted 12 months postimplementation.ResultsIn total, 1459 patients completed the Edmonton Symptom Assessment System Revised: Renal; 58% of eligible patients completed the preimplementation survey (n=718), and 56% of patients who completed the Edmonton Symptom Assessment System Revised: Renal at least once completed the postimplementation survey (n=569). Provider survey response rates were 71% (n=514) and 54% (n=319), respectively. Nine patients/caregivers from three sites and 48 providers from all sites participated in interviews. A total of 1207 charts were audited. Seven of eight sites had mean screening rates over 80%, suggesting that routine use of the Edmonton Symptom Assessment System Revised: Renal in clinical practice is feasible. However, the multiple data sources painted an inconsistent picture of the value and effect of the Edmonton Symptom Assessment System Revised: Renal. The Edmonton Symptom Assessment System Revised: Renal standardized symptom screening processes across providers and sites; improved patient and provider symptom awareness, particularly for psychosocial symptoms; and empowered patients to raise issues with providers. Yet, there was little, if any, statistically significant improvement in the metrics used to assess symptom management, patient-provider communication, and interdisciplinary communication.ConclusionsThe Edmonton Symptom Assessment System Revised: Renal patient-reported outcome measure may be useful to standardize symptom screening, enhance awareness of psychosocial symptoms among patients and providers, and empower patients rather than to reduce symptom burden.

scholarly journals Validation of the Edmonton Symptom Assessment System in Korean Patients With Cancer

2013 ◽  
Vol 46 (6) ◽  
pp. 947-956 ◽  
Author(s):  
Jung Hye Kwon ◽  
Seung-Hyun Nam ◽  
Sujin Koh ◽  
Young Seon Hong ◽  
Kyung Hee Lee ◽  
...  
Keyword(s):  
Symptom Assessment ◽  
Assessment System ◽  
Edmonton Symptom Assessment System ◽  
Korean Patients ◽  
Patients With Cancer

The Optimal Cutoff Point for Expressing Revised Edmonton Symptom Assessment System Scores as Binary Data Indicating the Presence or Absence of Symptoms

2018 ◽  
Vol 35 (11) ◽  
pp. 1390-1393 ◽  
Author(s):  
Jun Kako ◽  
Masamitsu Kobayashi ◽  
Yusuke Kanno ◽  
Asao Ogawa ◽  
Tomofumi Miura ◽  
...  
Keyword(s):  
Binary Data ◽  
Area Under The Curve ◽  
Symptom Assessment ◽  
Physical Symptoms ◽  
Assessment System ◽  
Cutoff Point ◽  
Optimal Cutoff ◽  
Edmonton Symptom Assessment System ◽  
Patients With Cancer ◽  
Optimal Cutoff Point

Context: Terminally ill patients with cancer experience various physical and emotional symptoms that have a negative impact on quality of life and activities of daily living. Recently, revised Edmonton Symptom Assessment System (ESAS-r) scores have been proposed for assessing symptoms in terminally ill patients with cancer. Objective: To determine the optimal cutoff point for expressing ESAS-r scores as binary data, indicating the presence or absence of symptoms. Methods: We conducted a retrospective study of patients hospitalized in the palliative care unit of our hospital between September 1, 2014 and May 31, 2015. To determine the optimal cutoff point for expressing ESAS-r scores as binary data, indicating the presence or absence of 6 physical symptoms (“pain,” “tiredness,” “drowsiness,” “nausea,” “lack of appetite,” and “dyspnea”), the sensitivity and specificity of each measurement were calculated. Cutoff points were estimated using receiver operating characteristic curve analysis. Results: Data from 157 patients who performed the self-assessment in ESAS-r scores were analyzed. The mean age was 66.5 years. Approximately 60.0% of patients were male. The optimal cutoff point for pain, tiredness, drowsiness, nausea, lack of appetite, and dyspnea was 4, 4, 4, 2, 5, and 4, respectively. The area under the curve for tiredness, nausea, and dyspnea was >0.70, followed in order by pain, lack of appetite, and drowsiness. The area under the curve for drowsiness was 0.55. Conclusion: Our results suggest that physical symptoms other than drowsiness could potentially predict ESAS-r score severity.

Opioid Prescription After Pain Assessment: A Population-Based Cohort of Elderly Patients With Cancer

2012 ◽  
Vol 30 (10) ◽  
pp. 1095-1099 ◽  
Author(s):  
Lisa Barbera ◽  
Hsien Seow ◽  
Amna Husain ◽  
Doris Howell ◽  
Clare Atzema ◽  
...  
Keyword(s):  
Pain Score ◽  
Pain Assessment ◽  
Severe Pain ◽  
Multivariable Analysis ◽  
Cancer Type ◽  
Opioid Prescription ◽  
Factors Associated ◽  
Patients With Cancer ◽  
Symptom Screening ◽  
The Impact

Purpose The purpose of this study was to measure opioid prescription (OP) rates in elderly cancer outpatients around the time of assessment for pain and to evaluate factors associated with receiving OPs for those with severe pain. Patients and Methods The cross-sectional cohort includes all patients with cancer in Ontario older than age 65 years who completed a pain assessment as part of a provincial initiative of systematic symptom screening. Patients were assigned to mutually exclusive categories by pain score severity: 0, 1 to 3 (mild), 4 to 6 (moderate), and 7 to 10 (severe). We linked multiple provincial health databases to examine the proportion of patients with an OP within 7 days after or 30 days before the assessment date. We examined factors associated with OPs for patients with pain scores of 7 to 10. Results The proportion of patients with an OP increased as pain score severity increased: 10% of those with no pain, 24% of those with mild pain, 45% of those with moderate pain, and 67% of those with severe pain. More specifically, for those with severe pain, 41% filled an OP within 7 days of assessment for pain, and 26% had an OP from the 30 days before assessment for pain, leaving 33% without an OP. In multivariable analysis, factors associated with OPs are younger age, male sex, comorbid illness, cancer type, and assessment at home. Conclusion Despite a generous time window for capturing OPs, the proportion of patients without an OP seems high. Further knowledge translation is required to maximize the impact of the symptom screening initiative in Ontario and to optimize management of cancer-related pain.

Tolerability of the combination of ginger (Zingiber officinalis), gentian (Gentiana lutea) and turmeric (Curcuma longa) in patients with cancer-associated anorexia

2015 ◽  
Vol 12 (1) ◽  
Author(s):  
Michael Sanatani ◽  
Jawaid Younus ◽  
Larry Stitt ◽  
Nazish Malik
Keyword(s):  
Curcuma Longa ◽  
Symptom Assessment ◽  
Assessment System ◽  
Common Symptom ◽  
Edmonton Symptom Assessment System ◽  
Future Studies ◽  
Patients With Cancer ◽  
Gentiana Lutea ◽  
Exploratory Data ◽  
Unacceptable Toxicity

Abstract: Anorexia is a common symptom for patients with advanced cancer. Gentian, ginger, and turmeric have traditionally been used to stimulate appetite. We tested these agents in combination, in a pilot study to assess tolerability in patients indicating 4/10 or worse anorexia on the Edmonton Symptom Assessment System, and who were not currently on chemotherapy. We collected exploratory data on the patient’s appetite using a visual analogue scale.: Between 2009 and 2012, 17 patients were enrolled in arm 1 (turmeric 1 g and ginger 1 g orally twice daily, and: In arm 1, seven patients (41%) completed treatment. Seven patients (41%) stopped early because of unacceptable toxicity or patient-initiated discontinuation, and 3 stopped because of other reasons. All patients in arm 2 stopped taking the study medication within few days of starting the treatment, leading the study committee to recommend stopping the trial. The most common adverse effects attributed to study drugs were nausea (6 patients), vomiting (3), fatigue (3), diarrhea (2) and bloating (2). There was no statistically significant effect seen on appetite.: At the doses used in this study, the combination of ginger, turmeric, and gentian is not tolerated well in cancer patients. Future studies should use fewer agents or lower doses.

Trajectory of Performance Status and Symptom Scores for Patients With Cancer During the Last Six Months of Life

2011 ◽  
Vol 29 (9) ◽  
pp. 1151-1158 ◽  
Author(s):  
Hsien Seow ◽  
Lisa Barbera ◽  
Rinku Sutradhar ◽  
Doris Howell ◽  
Deborah Dudgeon ◽  
...  
Keyword(s):  
Performance Status ◽  
Symptom Assessment ◽  
Well Being ◽  
Assessment System ◽  
Assessment Tools ◽  
Future Research ◽  
Patients With Cancer ◽  
Average Pain ◽  
Observational Cohort ◽  
Over Time

Purpose Ontario's cancer system is unique because it has implemented two standardized assessment tools population-wide to improve care: the Edmonton Symptom Assessment System (ESAS) measures severity of nine symptoms (scale 0 to 10; 10 indicates the worst) and the Palliative Performance Scale (PPS) measures performance status (scale 0 to 100; 0 indicates death). This article describes the trajectory of ESAS and PPS scores 6 months before death. Patients and Methods Observational cohort study of cancer decedents between 2007 and 2009. Decedents required ≥1 ESAS or PPS assessment in the 6 months before death for inclusion. Outcomes were the decedents' average ESAS and PPS scores per week before death. Results Ten thousand seven hundred fifty-two (ESAS) and 7,882 (PPS) decedents were included. The mean age was 65 years, half were female, and approximately 75% of assessments occurred in cancer clinics. Average PPS score declined slowly over the 6 months before death, starting at approximately 70 and ending at 40, declining more rapidly in the last month. For ESAS symptoms, average pain, nausea, anxiety, and depression scores remained relatively stable over the 6 months. Conversely, shortness of breath, drowsiness, well-being, lack of appetite, and tiredness increased in severity over time, particularly in the month before death. More than one third of the cohort reported moderate to severe scores (ie, 4 to 10) for most symptoms in the last month of life. Conclusion In this large outpatient cancer population, trajectories of mean ESAS scores followed two patterns: increasing versus generally flat. The latter was perhaps due to available treatment (eg, prescriptions) for those symptoms. Future research should prioritize addressing symptoms that worsen over time.

scholarly journals Avaliação do instrumento Edmonton Symptom Assessment System em cuidados paliativos: revisão integrativa

2010 ◽  
Vol 31 (4) ◽  
pp. 785-793 ◽  
Author(s):  
Daiane da Rosa Monteiro ◽  
Maria Henriqueta Luce Kruse ◽  
Miriam de Abreu Almeida
Keyword(s):  
Retrieval System ◽  
Medical Literature ◽  
Symptom Assessment ◽  
Assessment System ◽  
Literature Analysis ◽  
Edmonton Symptom Assessment System

Cuidados Paliativos (CP) são prestados a pacientes fora de possibilidades terapêuticas de cura, tendo como foco o controle dos sintomas e melhora da qualidade de vida. A Edmonton Symptom Assessment System (ESAS) é um instrumento para avaliar e monitorar nove sintomas físicos e psicológicos em pacientes de CP. O estudo objetiva realizar revisão integrativa acerca da avaliação dos profissionais de saúde e/ou pacientes quanto ao uso da ESAS em pacientes oncológicos em Cuidados Paliativos. Foram localizados oito artigos no Medical Literature Analysis and Retrieval System Online (MEDLINE) entre 1998 e 2009. Os resultados mostraram que apesar de haver poucos estudos sobre este assunto, a ESAS é um instrumento válido para detectar e monitorar sintomas nos CP, apresentando algumas limitações. Os resultados apontam para a importância da continuidade do estudo de tradução e adaptação transcultural desta escala para o português do Brasil.

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