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Utility of the revised Edmonton Symptom Assessment System (ESAS-r) and the Patient-Reported Functional Status (PRFS) in lung cancer patients

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Abstract

Background

Symptom palliation is an important objective of treatment in advanced/metastatic lung cancer (LC). Significant psychological, minor physical symptoms and several social/emotional issues often go unnoticed. This prospective study aimed to evaluate utility of patients’ perspectives [self-reported symptom assessment by revised Edmonton Symptom Assessment System (ESAS-r) and self-reported functional status by Patient-Reported Functional Status (PRFS)] amongst LC patients undergoing chemotherapy.

Methods

Consecutive newly diagnosed treatment-naïve LC patients attending a tertiary referral center in North India from January 2014 to March 2015 were included. All patients received standard histology-guided platinum-doublet chemotherapy. ESAS-r and PRFS questionnaires were administered under guidance, once at the time of initial assessment/diagnosis, repeated at start of chemotherapy, before C4, and after completion of chemotherapy (end of chemotherapy (EOCTx)). Functional Assessment of Cancer Therapy-Lung (FACT-L) questionnaire was also administered. Baseline and post-treatment scores were compared.

Results

Majority of 133 patients enrolled were males (86.5%,n = 115), were current/ex-smokers (81.2%, n = 108), had advanced stage [IIIB = 30.1% (n = 40), IV = 52.6% (n = 70)], and were of non-small-cell type (NSCLC;84.2%,n = 112). On baseline ESAS-r, the highest mean symptom scores were observed for tiredness followed by anorexia. Mean ESAS-r scores before C4 as well as at EOCTX were significantly better than baseline ESAS-r scores in all its components except nausea. Similarly, PRFS before C4 and EOCTx was significantly improved compared to baseline. However, Karnofsky Performance Scale (KPS) and Eastern Cooperative Oncology Group Performance Status assessed at baseline did not show significant improvement at treatment completion. FACT-L score at EOCTx showed significant improvement from baseline in physical and functional well-being domains but not for social/family and emotional well-being domains.

Conclusion

This study validated utility of ESAS-r and PRFS in Indian LC patients. These instruments should be used in routine clinical practice besides physicians’ assessment of PS (KPS/ECOG).

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References

  1. Singh N, Aggarwal AN, Gupta D et al (2010) Unchanging clinico-epidemiological profile of lung cancer in north India over three decades. Cancer Epidemiol 34:101–104

    Article  PubMed  Google Scholar 

  2. Singh N, Aggarwal AN, Gupta D et al (2012) Quantified smoking status and non-small cell lung cancer stage at presentation: analysis of a North Indian cohort and a systematic review of literature. J Thorac Dis 4:474–484

    PubMed  PubMed Central  Google Scholar 

  3. WHO definition of palliative care, 2015; Fact sheet N°402 (accessible at http://www.who.int/cancer/palliative/definition/en; last accessed March 422, 2017)

  4. Temel JS, Greer JA, Muzikansky A et al (2010) Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 363:733–742

    Article  CAS  PubMed  Google Scholar 

  5. Singh N, Behera D (2014) Palliation in metastatic non-small cell lung cancer: early integration with standard oncological care is the key. Lung India 31:317–319

    Article  PubMed  PubMed Central  Google Scholar 

  6. Singh N, Aggarwal AN, Behera D (2012) Management of advanced lung cancer in resource-constrained settings: a perspective from India. Expert Rev Anticancer Ther 12:1479–1495

    Article  CAS  PubMed  Google Scholar 

  7. Kaur H, Sehgal IS, Bal A et al (2017) Evolving epidemiology of lung cancer in India: reducing non-small cell lung cancer-not otherwise specified and quantifying tobacco smoke exposure are the key. Indian J Cancer. https://doi.org/10.4103/ijc.IJC_597_16

  8. Jindal SK, Malik SK, Dhand R et al (1982) Bronchogenic carcinoma in Northern India. Thorax 37:343–347

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Watanabe SM, Nekolaichuk C, Beaumont C et al (2011) A multicenter study comparing two numerical versions of the Edmonton Symptom Assessment System in palliative care patients. J Pain Symptom Manag 41:456–468

    Article  Google Scholar 

  10. Dudgeon DJ, Harlos M, Clinch JJ (1999) The Edmonton Symptom Assessment Scale (ESAS) as an audit tool. J Palliat Care 15:14–19

    CAS  PubMed  Google Scholar 

  11. Bruera E, Kuehn N, Miller MJ et al (1991) The Edmonton Symptom Assessment System (ESAS): a simple method for the assessment of palliative care patients. J Palliat Care 7:6–9

    CAS  PubMed  Google Scholar 

  12. Singh N, Aggarwal AN, Behera D et al (2010) Intercycle delays during chemotherapy of non-small cell lung cancer in a health care resource-constrained setting and their effect on overall survival. J Thorac Oncol 5:236–239

    Article  PubMed  Google Scholar 

  13. Singh N, Mootha VK, Madan K et al (2013) Tumor cavitation among lung cancer patients receiving first-line chemotherapy at a tertiary care centre in India: association with histology and overall survival. Med Oncol 30:602

    Article  PubMed  Google Scholar 

  14. Singh N, Singh PS, Aggarwal AN et al (2016) Comorbidity assessment using Charlson Comorbidity Index and Simplified Comorbidity Score and its association with clinical outcomes during first-line chemotherapy for lung cancer. Clin Lung Cancer 17:205–213.e201

    Article  PubMed  Google Scholar 

  15. Therasse P, Arbuck SG, Eisenhauer EA et al (2000) New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 92:205–216

    Article  CAS  PubMed  Google Scholar 

  16. Common terminology criteria for adverse events, Version 3.0: cancer therapy evaluation program, 2006

  17. Singh N, Aggarwal AN, Kaur J et al (2017) Association of graded folic acid supplementation and total plasma homocysteine levels with hematological toxicity during first-line treatment of nonsquamous NSCLC patients with pemetrexed-based chemotherapy. Am J Clin Oncol 40:75–82

    Article  CAS  PubMed  Google Scholar 

  18. Silvoniemi M, Vasankari T, Loyttyniemi E et al (2016) Symptom assessment for patients with non-small cell lung cancer scheduled for chemotherapy. Anticancer Res 36:4123–4128

    CAS  PubMed  Google Scholar 

  19. Seow H, Barbera L, Sutradhar R et al (2011) Trajectory of performance status and symptom scores for patients with cancer during the last six months of life. J Clin Oncol 29:1151–1158

    Article  PubMed  Google Scholar 

  20. Montoya M, Fossella F, Palmer JL et al (2006) Objective evaluation of physical function in patients with advanced lung cancer: a preliminary report. J Palliat Med 9:309–316

    Article  PubMed  Google Scholar 

  21. Steinberg T, Roseman M, Kasymjanova G et al (2009) Prevalence of emotional distress in newly diagnosed lung cancer patients. Support Care Cancer 17:1493–1497

    Article  PubMed  Google Scholar 

  22. Kasymjanova G, Grossman M, Tran T et al (2013) The potential role for acupuncture in treating symptoms in patients with lung cancer: an observational longitudinal study. Curr Oncol 20:152–157

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Nowicki A, Farbicka P, Krajnik M (2015) Dejection and self-assessment of quality of life in patients with lung cancer subjected to palliative care. Contemp Oncol (Pozn) 19:491–495

    Google Scholar 

  24. Taylor AE, Olver IN, Sivanthan T et al (1999) Observer error in grading performance status in cancer patients. Support Care Cancer 7:332–335

    Article  CAS  PubMed  Google Scholar 

  25. O'Brien ME, Socinski MA, Popovich AY et al (2008) Randomized phase III trial comparing single-agent paclitaxel Poliglumex (CT-2103, PPX) with single-agent gemcitabine or vinorelbine for the treatment of PS 2 patients with chemotherapy-naive advanced non-small cell lung cancer. J Thorac Oncol 3:728–734

    Article  PubMed  Google Scholar 

  26. Langer CJ, O'Byrne KJ, Socinski MA et al (2008) Phase III trial comparing paclitaxel poliglumex (CT-2103, PPX) in combination with carboplatin versus standard paclitaxel and carboplatin in the treatment of PS 2 patients with chemotherapy-naive advanced non-small cell lung cancer. J Thorac Oncol 3:623–630

    Article  PubMed  Google Scholar 

  27. Yenge LB, Behera D, Garg M et al (2017) Comparison of symptom score and bronchoscopy-based assessment with conventional computed tomography-based assessment of response to chemotherapy in lung cancer. J Glob Oncol 3:370–379

    Article  PubMed  Google Scholar 

  28. Heedman PA, Strang P (2001) Symptom assessment in advanced palliative home care for cancer patients using the ESAS: clinical aspects. Anticancer Res 21:4077–4082

    CAS  PubMed  Google Scholar 

  29. Singh PS, Aggarwal AN, Behera D et al (2017) Simplified graded baseline symptom assessment in patients with lung cancer undergoing first-line chemotherapy: correlations and prognostic role in a resource-constrained setting. J Glob Oncol 3:54–63

    Article  PubMed  Google Scholar 

  30. Reddy SK, Parsons HA, Elsayem A et al (2009) Characteristics and correlates of dyspnea in patients with advanced cancer. J Palliat Med 12:29–36

    Article  PubMed  Google Scholar 

  31. Gupta M, Sahi MS, Bhargava AK et al (2016) A prospective evaluation of symptom prevalence and overall symptom burden among cohort of critically ill cancer patients. Indian J Palliat Care 22:118–124

    Article  PubMed  PubMed Central  Google Scholar 

  32. Fan G, Hadi S, Chow E (2007) Symptom clusters in patients with advanced-stage cancer referred for palliative radiation therapy in an outpatient setting. Support Cancer Ther 4:157–162

    Article  PubMed  Google Scholar 

  33. Cheung WY, Le LW, Zimmermann C (2009) Symptom clusters in patients with advanced cancers. Support Care Cancer 17:1223–1230

    Article  PubMed  Google Scholar 

  34. Barbera L, Seow H, Howell D et al (2010) Symptom burden and performance status in a population-based cohort of ambulatory cancer patients. Cancer 116:5767–5776

    Article  PubMed  Google Scholar 

  35. Zeng L, Koo K, Zhang L et al (2012) Fatigue in advanced cancer patients attending an outpatient palliative radiotherapy clinic as screened by the Edmonton Symptom Assessment System. Support Care Cancer 20:1037–1042

    Article  PubMed  Google Scholar 

  36. Gralla RJ, Edelman MJ, Detterbeck FC et al (2009) Assessing quality of life following neoadjuvant therapy for early stage non-small cell lung cancer (NSCLC): results from a prospective analysis using the Lung Cancer Symptom Scale (LCSS). Support Care Cancer 17:307–313

    Article  PubMed  Google Scholar 

  37. Hollen PJ, Gralla RJ, Kris MG et al (1993) Quality of life assessment in individuals with lung cancer: testing the Lung Cancer Symptom Scale (LCSS). Eur J Cancer 29A(Suppl 1):S51–S58

    Article  PubMed  Google Scholar 

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Correspondence to Navneet Singh.

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Informed consent was obtained from all enrolled patients and the study was approved by the institutional ethics committee.

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The authors declare that they have no conflict of interest.

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Yogananda, M.N., Muthu, V., Prasad, K.T. et al. Utility of the revised Edmonton Symptom Assessment System (ESAS-r) and the Patient-Reported Functional Status (PRFS) in lung cancer patients. Support Care Cancer 26, 767–775 (2018). https://doi.org/10.1007/s00520-017-3887-1

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