Symptom improvement as prognostic factor for survival in cancer patients undergoing palliative care: A pilot study

Filomena Narducci, Roberta Grande, Lucia Mentuccia, Tiziana Trapasso, Isabella Sperduti, Emanuela Magnolfi, Anna Maria Fariello, Donatello Gemma, Teresa Gamucci

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The Edmonton Symptom Assessment Scale (ESAS) is a validated tool for physical symptom assessment in palliative care practice which evaluates symptoms through a numeric scale from 0 to 10. The use of symptom improvement as a prognostic factor is controversial. To this purpose, a pilot study in advanced cancer patients now undergoing only palliative care was conducted. Methods: Patients were considered eligible if no longer able to receive any anticancer treatment; they were scheduled to undergo ESAS assessment at the hospitalization and hospital discharge time points. Symptoms' scores were divided into three severity classes: mild, moderate and severe. Differences across symptoms' classes between hospitalization and hospital discharge time points were analysed with the paired-data McNemar test, according to tumour types. Results: ESAS assessment was administered to 68 patients with gastrointestinal (39 patients) and nonsmall cell lung cancer (29 patients); median age was 69 years; Karnofsky Performance Status was 50 in 27 (39.7%) patients and >50 in 41 (60.3%) patients. Palliative Prognostic Score was A for 26 (38.2%) patients, B for 37 (54.4%) patients and C for 5 (7.4%) patients. A statistically significant reduction of severe severity class rates was observed. Symptom improvement correlates with survival improvement: Palliative Prognostic Score (hazard ratio (HR) 2.95, 95% CI 1.35-6.41, p=0.006) and anorexia (HR 3.21, 95% 1.33-7.72, p=0.009) appear to be prognostic factors for survival at the multivariate analysis for gastrointestinal cancer patients; asthenia is the only significant variable (HR 5.11, 95% CI 1.86-14.03, p=0.002) for non-small cell lung cancer patients. Conclusions: Symptom improvement according to ESAS after palliative care treatment represents an important prognostic for survival in patients no longer suitable to receive any anticancer active therapies.

Original languageEnglish
Pages (from-to)1221-1226
Number of pages6
JournalSupportive Care in Cancer
Volume20
Issue number6
DOIs
Publication statusPublished - Jun 2012

Keywords

  • Advanced cancer
  • Palliative care
  • Prognostic score
  • Survival

ASJC Scopus subject areas

  • Oncology

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