• Cancer medicine · Jan 2020

    Are population-based patient-reported outcomes associated with overall survival in patients with advanced pancreatic cancer?

    • Wei Fang Dai, Jaclyn Beca, Helen Guo, Wanrudee Isaranawatchai, Deborah Schwartz, Rohini Naipaul, Jessica Arias, Yao Qiao, Scott Gavura, Ruby Redmond-Misner, Zahra Ismail, Lisa Barbera, and Kelvin Chan.
    • Cancer Care Ontario, Toronto, ON, Canada.
    • Cancer Med. 2020 Jan 1; 9 (1): 215-224.

    BackgroundAdvanced pancreatic cancer (APC) patients often have substantial symptom burden. In Ontario, patients routinely complete the Edmonton Symptom Assessment Scale (ESAS), which screens for nine symptoms (scale: 0-10), in cancer clinics. We explored the association between baseline patient-reported outcomes, via ESAS, and overall survival (OS).MethodsAdvanced pancreatic cancer patients with ESAS records prior to receiving publicly funded drugs from November 2008 to March 2016 were retrospectively identified from Cancer Care Ontario's administrative databases. We examined three composite ESAS scores: total symptom distress score (TSDS: 9 symptoms), physical symptom score (PHS: 6/9 symptoms), and psychological symptom score (PSS: 2/9 symptoms); Composite scores greater than defined thresholds (TSDS ≥36, PHS ≥24, PSS ≥8) were considered as high symptom burden. Crude OS was assessed using Kaplan-Meier method. Hazard ratios (HRs) were assessed using multivariable Cox models. Analysis was repeated in a sub-cohort with Eastern Cooperative Oncology Group (ECOG) status and metastasis.ResultsWe identified 2199 APC patients (mean age 64 years, 55% male) with ESAS records prior to receiving chemotherapy. Crude median survival was 4.5 and 7.3 months for high and low TSDS, respectively. High TSDS was associated with lower OS (HR = 1.47, 95% CI: 1.33, 1.63). In the sub-cohort (n = 393) with ECOG status and metastasis, high TSDS was also associated with lower OS (HR = 1.34, 95% CI: 1.04, 1.73). Similar trends were observed for PHS and PSS.ConclusionsHigher burden of patient-reported outcome was associated with reduced OS among APC patients. The effect was prominent after adjusting for ECOG status.© 2019 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

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