TY - JOUR
T1 - Testing symptom severity thresholds and potential alerts for clinical intervention in patients with cancer undergoing chemotherapy
AU - Shi, Qiuling
AU - Lee, Ju Whei
AU - Wang, Xin Shelley
AU - Fisch, Michael J.
AU - Chang, Victor T.
AU - Wagner, Lynne
AU - Cleeland, Charles S.
N1 - Funding Information:
This study was coordinated by the ECOG-ACRIN Cancer Research Group (Peter J. O’Dwyer, MD, and Mitchell D. Schnall, MD, PhD, group cochairs) and supported by the National Cancer Institute of the National Institutes of Health (Awards No. CA189828 and CA180858), the MD Anderson Cancer Center Support grant from the National Cancer Institute (Grant No. P30 CA016672; primary investigator [PI] Pisters), and the US National Cancer Institute (Grant No. R01 CA205146; PI X.S.W.).
Publisher Copyright:
© 2020 by American Society of Clinical Oncology
PY - 2020/9/1
Y1 - 2020/9/1
N2 - PURPOSE Symptom monitoring is attracting attention as a way to improve adherence to cancer therapy, reduce treatment-related toxicities, and possibly improve overall survival. How reporting thresholds affect symptom alert generation and clinical outcomes is poorly understood. PATIENTS AND METHODS We analyzed data from 38 US health care institutions collected for the prospective Eastern Cooperative Oncology Group-American College of Radiology Imaging Network E2Z02 Symptom Outcomes and Practice Patterns study. Participants were outpatients receiving chemotherapy for breast (n 5 642), colorectal (n 5 486), or lung cancer (n 5 340) who rated symptom severity using the MD Anderson Symptom Inventory at 2 assessment points 1 month apart. Percentages of patients with pain, dyspnea, fatigue, or distress at different thresholds (score of 4-7 on a 0-10 scale) were compared. The percentage of patients whose performance status had worsened at follow-up was used to estimate risk for missing clinically important symptom data by using higher severity thresholds RESULTS At the guideline-recommended threshold of $ 4, suprathreshold rates were 60% for any of the 4 symptoms at the initial survey; performance status worsened at follow-up for 27% of all patients with any symptom rated $ 4 at the initiate survey. When the threshold was increased to $ 7, approximately half of patients (51%) with worsened performance status were not identified. CONCLUSION The burden to clinicians from an alert threshold of $ 4 (per many current guidelines) would be substantial. However, setting higher alert thresholds may miss a large percentage of patients who need clinical intervention. These results may inform resource planning when implementing electronic symptom screening at an institutional or practice level.
AB - PURPOSE Symptom monitoring is attracting attention as a way to improve adherence to cancer therapy, reduce treatment-related toxicities, and possibly improve overall survival. How reporting thresholds affect symptom alert generation and clinical outcomes is poorly understood. PATIENTS AND METHODS We analyzed data from 38 US health care institutions collected for the prospective Eastern Cooperative Oncology Group-American College of Radiology Imaging Network E2Z02 Symptom Outcomes and Practice Patterns study. Participants were outpatients receiving chemotherapy for breast (n 5 642), colorectal (n 5 486), or lung cancer (n 5 340) who rated symptom severity using the MD Anderson Symptom Inventory at 2 assessment points 1 month apart. Percentages of patients with pain, dyspnea, fatigue, or distress at different thresholds (score of 4-7 on a 0-10 scale) were compared. The percentage of patients whose performance status had worsened at follow-up was used to estimate risk for missing clinically important symptom data by using higher severity thresholds RESULTS At the guideline-recommended threshold of $ 4, suprathreshold rates were 60% for any of the 4 symptoms at the initial survey; performance status worsened at follow-up for 27% of all patients with any symptom rated $ 4 at the initiate survey. When the threshold was increased to $ 7, approximately half of patients (51%) with worsened performance status were not identified. CONCLUSION The burden to clinicians from an alert threshold of $ 4 (per many current guidelines) would be substantial. However, setting higher alert thresholds may miss a large percentage of patients who need clinical intervention. These results may inform resource planning when implementing electronic symptom screening at an institutional or practice level.
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U2 - 10.1200/JOP.19.00403
DO - 10.1200/JOP.19.00403
M3 - Article
C2 - 32369412
AN - SCOPUS:85090750118
SN - 2688-1527
VL - 16
SP - E893-E901
JO - JCO Oncology Practice
JF - JCO Oncology Practice
IS - 9
ER -