Strahlentherapie und Onkologie

, Volume 194, Issue 6, pp 533–538 | Cite as

Patient-reported symptoms before palliative radiotherapy predict survival differences

  • Carsten Nieder
  • Thomas A. Kämpe
  • Adam Pawinski
  • Astrid Dalhaug
Original Article

Abstract

Background

Widely used prognostic scores, e. g., for brain or bone metastases, are based on disease- and patient-related factors such as extent of metastases, age and performance status, which were available in the databases used to develop the scores. Few groups were able to include patient-reported symptoms. In our department, all patients were assessed with the Edmonton Symptom Assessment System (ESAS, a one-sheet questionnaire addressing 11 major symptoms and wellbeing on a numeric scale of 0–10) at the time of treatment planning since 2012. Therefore, we analyzed the prognostic impact of baseline ESAS symptom severity.

Methods

Retrospective review of 102 patients treated with palliative radiotherapy (PRT) between 2012 and 2015. All ESAS items were dichotomized (below/above median). Uni- and multivariate analyses were performed to identify prognostic factors for survival.

Results

The most common tumor types were prostate, breast and non-small cell lung cancer, predominantly with distant metastases. Median survival was 6 months. Multivariate analysis resulted in six significant prognostic factors. These were ESAS pain while not moving (median 3), ESAS appetite (median 5), Eastern Cooperative Oncology Group (ECOG) performance status, pleural effusion/metastases, intravenous antibiotics at start or within 2 weeks before PRT and no systemic cancer treatment.

Conclusions

Stronger pain while not moving and reduced appetite (below/above median) predicted significantly shorter survival. Development of new prognostic scores should include patient-reported symptoms and other innovative parameters because they were more important than primary tumor type, age and other traditional baseline parameters.

Keywords

Palliative radiotherapy Edmonton symptom assessment system Cancer Prognostic factors 

Patientenberichtete Symptome vor palliativer Strahlentherapie sagen Überlebensunterschiede voraus

Zusammenfassung

Hintergrund

Verbreitete prognostische Scores, z. B. für Hirn- oder Knochenmetastasen, basieren auf tumor- und patientenbezogenen Faktoren, wie Ausbreitung der Metastasen, Alter und Leistungszustand, die in den zugrundeliegenden Datenbanken registriert waren. Nur wenige Arbeitsgruppen konnten auch die von den Patienten berichteten Symptome einschließen. In unserer Klinik wurden seit 2012 alle Patienten bei der Bestrahlungsplanung mit dem Edmonton-Symptom-Assessment-System (ESAS; einseitiger Fragebogen, der 11 Hauptsymptome und das Wohlbefinden auf einer Skala von 0–10 erfasst) evaluiert. Daher wurde nun die prognostische Bedeutung der prätherapeutischen ESAS-Daten analysiert.

Methoden

Retrospektive Auswertung von 102 Patienten, die zwischen 2012 und 2015 eine palliative Radiotherapie (PRT) erhielten. Alle ESAS-Items wurden dichotomisiert (unter/über dem Medianwert). Es erfolgten uni- und multivariate Analysen, um prognostische Faktoren für das Überleben zu finden.

Ergebnisse

Bei vielen Patienten lagen metastasierte Tumoren vor, häufig Prostata‑, Mamma- und nicht-kleinzellige Bronchialkarzinome. Das mediane Überleben betrug 6 Monate. In der multivariaten Analyse waren 6 Faktoren signifikant mit dem Überleben assoziiert: ESAS-Ruheschmerz (Medianwert 3), ESAS-Appetit (Medianwert 5), ECOG-Leistungszustand, pleurale Metastasen oder Erguss, intravenöse Antibiotika bei PRT-Start oder in den zurückliegenden 2 Wochen und keine Gabe einer systemischen Therapie.

Schlussfolgerung

Stärkere Ruheschmerzen und reduzierter Appetit (über/unter dem Medianwert) waren mit einem signifikant kürzeren Überleben assoziiert. Bei der Entwicklung neuer Prognosescores sollten die von den Patienten berichteten Symptome und andere innovative Parameter inkludiert werden, da diese sich als wichtiger erwiesen als andere Basisdaten, einschließlich des Primärtumors und des Alters.

Schlüsselwörter

Palliative Radiotherapie Edmonton-Symptom-Assessment-System Krebs Prognostische Faktoren 

Notes

Conflict of interest

C. Nieder, T.A. Kämpe, A. Pawinski and A. Dalhaug declare that they have no competing interests.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Oncology and Palliative MedicineNordland Hospital TrustBodøNorway
  2. 2.Department of Clinical Medicine, Faculty of Health SciencesUiT—The Artic University of NorwayTromsøNorway

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