Prospective Study of Use of Edmonton Symptom Assessment Scale Versus Routine Symptom Management During Weekly Radiation Treatment Visits

Abstract

ANSWER: Incorporation of ESAS for OTVs was associated with stable or improved symptom severity where therapeutic intervention is more readily available, such as counseling, pain medication, anti-emetics, appetite stimulants, and anti-anxiolytics. The incorporation of validated patient-reported symptom-scoring tools may improve provider management. WHAT WE DID: As an institutional quality improvement project, patients were partitioned into 2 groups: (1) 85 patients completing weekly ESAS but blinded to their providers who gave routine symptom management and (2) 170 patients completing weekly ESAS (intervention group) reviewed by providers during weekly OTVs with possible intervention. To determine the independent association of the intervention with symptom severity, multivariate logistic regression was performed. WHAT WE FOUND: Compared with the nonintervention group, stable or improved symptom severity was seen in the intervention group for pain (70.7% v 85.6%; P 5.005) and anxiety (79.3% v 92.9%; P 5 .002). The intervention group had decreased association with worsening severity of pain (odds ratio [OR], 0.13; P , .001), nausea (OR, 0.25; P 5 .023), loss of appetite (OR, 0.30; P 5 .024), and anxiety (OR, 0.19; P 5 .005). BIAS, CONFOUNDING FACTORS The 2 groups in this study were surveyed during weekly OTVs, but patient compliance to complete surveys for every OTV was challenging. However, this difficulty with compliance may make our findings more realistic to day-today clinical practice. REAL-LIFE IMPLICATIONS The incorporation of validated patient self-reported symptom-scoring tools like ESAS into OTVs may improve provider management of common cancer and RT-related symptoms and may allow for earlier referrals to supportive care clinics. abstract PURPOSE During radiotherapy (RT), patient symptoms are evaluated and managed weekly during physician on-treatment visits (OTVs). The Edmonton Symptom Assessment Scale (ESAS) is a 9-symptom validated self-assessment tool for reporting common symptoms in patients with cancer. We hypothesized that implementation and physician review of ESAS during weekly OTVs may result in betterment of symptom severity during RT for certain modifiable domains. METHODS As an institutional quality improvement project, patients were partitioned into 2 groups: (1) 85 patients completing weekly ESAS (preintervention) but blinded to their providers who gave routine symptom management and (2) 170 completing weekly ESAS (postintervention group) reviewed by providers during weekly OTVs with possible intervention. To determine the independent association with symptom severity of the intervention , multivariate logistic regression was performed. At study conclusion, provider assessments of ESAS utility were also collected. RESULTS Compared with the preintervention group, stable or improved symptom severity was seen in the postintervention group for pain (70.7% v 85.6%; P 5 .005) and anxiety (79.3% v 92.9%; P 5 .002). The postintervention group had decreased association (on multivariate analysis) with worsening severity of pain (OR, 0.13; P , .001), nausea (OR, 0.25; P 5 .023), loss of appetite (OR, 0.30; P 5 .024), and anxiety (OR, 0.19; P 5 .005). Most physicians (87.5%) and nurses (75%) found ESAS review useful in symptom management. CONCLUSION Incorporation of ESAS for OTVs was associated with stable or improved symptom severity where therapeutic intervention is more readily available, such as counseling, pain medication, anti-emetics, appetite stimulants, and anti-anxiolytics. The incorporation of validated patient-reported symptom-scoring tools may improve provider management.