• Gynecologic oncology · Mar 2014

    Predictors of high symptom burden in gynecologic oncology outpatients: who should be referred to outpatient palliative care?

    • Carolyn Lefkowits, Michael W Rabow, Alexander E Sherman, Tuyen K Kiet, Rachel Ruskin, John K Chan, and Lee-may Chen.
    • Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA 94117, USA. Electronic address: caseylefkowitscj@upmc.edu.
    • Gynecol. Oncol. 2014 Mar 1;132(3):698-702.

    ObjectiveTo characterize symptom prevalence in gynecologic oncology outpatients and identify predictors of high symptom burden.MethodsWe performed a retrospective analysis of a convenience sample of symptom surveys from gynecologic oncology patients at a single cancer center over a 20-month period. The survey was based on the Edmonton Symptom Assessment System (ESAS), and assessed pain, depression, anxiety, fatigue and well-being. Information on demographics, disease, treatment and history of chronic pain, depression or anxiety was abstracted from medical records. Data was analyzed with descriptive and t-test statistics.ResultsWe analyzed 305 surveys from unique patients. Symptom prevalence (severity score>0/10) ranged from 60.1% (pain) to 79.7% (fatigue). Prevalence of moderate to severe symptoms (score≥4/10) ranged from 32% (pain) to 47% (fatigue). There were no differences in symptom burden by site or stage of cancer. Patients with no active disease (38%) were less symptomatic. There was a trend toward higher symptom burden in patients younger than 50years. There was higher symptom burden in patients receiving cancer treatment or with a pre-existing history of pain, anxiety or depression. Patients who expressed an interest in being seen by a symptom management service also had higher symptom burden.ConclusionsGynecologic oncology outpatients have a high symptom burden regardless of stage and site of cancer. Patients who are young, on treatment or have a history of chronic pain, depression or anxiety have a higher symptom burden. Consideration should be given to targeting these patients for outpatient palliative care services.Copyright © 2014 Elsevier Inc. All rights reserved.

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