Contribution of Patient-reported Symptoms Before Palliative Radiotherapy to Development of Multivariable Prognostic Models

Anticancer Research
Carsten Nieder, Thomas A Kämpe

Abstract

Typically, prognostic scores predicting survival in patients with metastatic cancer are based on disease- and patient-related factors, such as extent of metastases, age and performance status. Patient-reported symptoms have been included less often. Our group has assessed all patients with the Edmonton Symptom Assessment System (ESAS, a one-sheet questionnaire addressing 11 major symptoms and wellbeing on a numeric scale of 0-10) before palliative radiotherapy (PRT) since 2012. Therefore, we were able to analyze the prognostic impact of baseline ESAS symptom severity. We performed a retrospective review of 102 patients treated with PRT between 2012 and 2015. All ESAS items were analyzed by two different methods, dichotomized by median score and by score <4 vs. ≥4. Uni- and multivariable analyses were performed to identify prognostic factors for survival, and from these a 4-tiered score was developed. The most common tumor types were prostate, breast and non-small cell lung cancer, predominantly with distant metastases. Despite differences between the two methods of ESAS data handling, the final multivariable models were strikingly similar. Therefore, the better reproducible cut-off was chosen, i.e. a score ≥4. Multivariable ana...Continue Reading

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