Symptom clusters and their influence on prognosis using EORTC QLQ-C15-PAL scores in terminally ill patients with cancer

Symptom Clusters in Patients with Brain Tumors: A Systematic Review

OBJECTIVES

To identify composition, predictors, outcomes and stability of symptom clusters in brain tumor patients and to examine assessment tools and statistical methods.

METHODS

The PubMed, Web of Science, Embase, CINAHL, and Cochrane Library databases were systematically searched. Two reviewers independently screened the titles, abstracts and full texts. Data were extracted and synthesized based on the aims of the review.

RESULTS

Eleven studies were included, covering eight symptom assessment tools and four analysis methods. Four symptom clusters in patients with primary brain tumors were identified: lack of energy cluster/ affective cluster/ gastrointestinal cluster/ neurocognitive cluster. Three symptom clusters in patients with brain metastases were identified: somatic stress cluster/ gastrointestinal cluster/ neurocognitive cluster. Longitudinal instability of symptom clusters was found. The severity of symptom clusters has a significant negative correlation with quality of life, performance status and functioning. There is little information on the predictors.

CONCLUSIONS

Although major symptom clusters of patients with primary brain tumors and brain metastases have been identified, methodological differences have affected the homogeneity of the inferences drawn. It is necessary to standardize the selection of assessment tools and statistical methods for symptom cluster research to facilitate comparison and combination across studies, and further clarify the temporal trajectories, predictive factors, and underlying mechanisms.

IMPLICATIONS FOR NURSING PRACTICE

Knowledge of symptom clusters contributes to the adoption of prevention strategies and management measures and the adjustment of treatments, thus alleviating symptom distress and improving quality of life.

Extension for Community Healthcare Outcomes-Palliative Care in Africa and Quality of Life, Symptoms, Patient Experience, and Caregiver Distress Among Patients With Cancer

PURPOSE

In this study, we aimed to evaluate the association between the Extension for Community Healthcare Outcomes-Palliative Care (ECHO-PC; ECHO Model-Based comprehensive educational and telementoring intervention) for health care professionals (HCPs) and change in patient-reported quality-of-life (QOL; Functional Assessment of Cancer Therapy-General [FACT-G]) among patients with advanced cancer. We also examined the association between ECHO-PC and changes in symptom distress (Edmonton Symptom Assessment Scale [ESAS]), patient experience and satisfaction, and caregiver distress scores.

METHODS

ECHO-PC Clinic sessions were conducted twice a month for 1 year by an interdisciplinary team of PC clinicians at the MD Anderson Cancer Center, with participation of experts in PC in sub-Saharan Africa, using standardized curriculum on the basis of PC needs in the region. Study participants included palliative HCPs from ECHO participating programs in Kenya, Nigeria, Ghana, and South Africa. HCPs, their patients, and caregivers were assessed at baseline, 3, 6, 9, and 12 months of the study for QOL (FACT-G), ESAS-Symptom Distress Score (prorated) (SDS), patient experience, satisfaction (FAMCARE-P-16-patient), and caregiver distress (FAMCARE-caregiver).

RESULTS

Two hundred seventy patients completed the assessments. Fifty-eight percent was female, the mean age was 56 years, and most common cancer type was breast cancer (24.3%). Multivariate generalized linear mixed model analysis found that ECHO-PC intervention was associated with significant improvement in QOL and symptom distress (FACT-G total score, P = .0433; FACT-G physical well-being, P < .013; FACT-G emotional well-being, P = .0232, and ESAS-SDS, P < .0001). No significant changes were found in patient experience, satisfaction, and caregiver distress scores.

CONCLUSION

Our preliminary study found that the ECHO-PC intervention was significantly associated with improvement in patient outcomes including QOL and symptom distress scores. Further studies are needed.

Correlation Between Cancer Pain and Quality of Life in Patients With Advanced Cancer Admitted to a Palliative Care Unit

INTRODUCTION

Cancer pain is one of the most prevalent manageable symptoms in patients with advanced cancer, and it has a negative impact on quality of life (QoL).

OBJECTIVE

The aim of this study is to examine the correlation between cancer pain and QoL in patients with advanced cancer who are hospitalized in a palliative care unit.

METHODS

This study is a cross-sectional analysis of patients with advanced cancer who were hospitalized with cancer pain at a specialized palliative care unit between June 2021 and February 2022. Pain intensity and its impact on daily activities were assessed using the Brief Pain Inventory (BPI), while the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 15 PAL (QLQ-C15-PAL) was used to evaluate QoL.

RESULTS

A total of 104 patients with cancer pain were included, with a mean age of 53.6 years (±14.1). Most of the patients were female (65.38%), and the most common primary tumor site was in the gastrointestinal tract (22.11%). The most frequently reported site of cancer pain was the abdomen (32.69%). The mean duration of cancer pain was 52.3 days (±6.2). The domains of QoL most strongly correlated with cancer pain were weakness (coefficient = .52, P < .001), nausea (coefficient = .36, P < .001), and the physical domain (coefficient = -.30, P < .001).

CONCLUSION

Cancer pain is strongly correlated with a deterioration in QoL in patients with advanced cancer, and its management should be pursued as a strategy for optimizing QoL.

Symptom Clusters in Patients With Advanced Cancer: A Prospective Longitudinal Cohort Study to Examine Their Stability and Prognostic Significance

This study's purpose was to assess symptom cluster (SC) stability during disease progression and determine their strength of association with survival in patients with advanced cancer . Consecutively eligible patients with advanced cancer not receiving cancer-specific treatment and referred to a Tertiary Palliative Care Clinic were enrolled in a prospective cohort study. At first consultation (D0) and in subsequent consultations at day 15 (D15) and day 30 (D30), patients rated 9 symptoms through the Edmonton Symptom Assessment System scale (0-10) and 10 others using a Likert scale (1-5). Principal components factor analysis with varimax rotation was used to determine SCs at each consultation. Of 318 patients with advanced cancer, 301 met eligibility criteria with a median age of 69 years (range 37-94). Three SCs were identified: neuro-psycho-metabolic (NPM), gastrointestinal, and sleep impairment, with some variations in their constitution over time. Exploratory factor analysis accounted for 40% of variance of observed variables in all SCs. Shorter median survival was observed continuously for NPM cluster (D0 23 vs. 58 days, P < .001; D15 41 vs. 104 days, P=.004; D30 46 vs. 114 days, P = .002), although the presence of 2 or more SCs on D0 and D15 also had prognostic significance (D0: 21 vs. 45 days, P = .005; D30: 50 vs. 96 days, P = .040). In a multivariable model, NPM cluster (D0 hazard ratio estimate: HR 1.64; 95%CI, 1.17-2.31; P = .005; D15 HR: 2.51; 95%CI, 1.25-5.05; P = .009; D30 HR: 3.9; 95%CI, 1.54-9.86; P = .004) and hospitalization (D0 HR: 2.27; 95%CI, 1.47-3.51; P < .001; D15 HR: 2.43; 95%CI, 1.18-5.01; P = .016; D30 HR: 3.41; 95%CI, 1.35-8.62; P = .009) were independently and significantly associated with worse survival. Three clinically relevant SCs were identified, and their constitution had small variations, maintaining a stable set of nuclear symptoms through disease progression. Presence of the NPM cluster and hospitalization maintained their prognostic value over time.

Symptom and problem clusters in German specialist palliative home care - a factor analysis of non-oncological and oncological patients' symptom burden

BACKGROUND

Specialist palliative home care (SPHC) aims to maintain and improve patients' quality of life in the community setting. Symptom burden may differ between oncological and non-oncological patients. However, little is known about diagnosis-related differences of SPHC patients. This study aims to describe the prevalence of physical symptom burden and psychosocial problems of adult patients in SPHC, and to evaluate diagnosis-related symptom clusters.

METHODS

Secondary analysis of data from a prospective, cross-sectional, multi-centre study on complexity of patients, registered at the German Register for Clinical Studies (DRKS trial registration number: DRKS00020517, 12/10/2020). Descriptive statistics on physical symptom burden and psychosocial problems at the beginning of care episodes. Exploratory and confirmatory factor analyses to identify symptom and problem clusters.

RESULTS

Seven hundred seventy-eight episodes from nine SPHC teams were included, average age was 75 years, mean duration of episode 18.6 days (SD 19.4). 212/778 (27.2%) had a non-oncological diagnosis. Main burden in non-oncological episodes was due to poor mobility (194/211; 91.9%) with significant diagnosis-related differences (χ² = 8.145, df = 1, p = .004; oncological: 472/562; 84.0%), and due to weakness (522/565; 92.4%) in oncological episodes. Two symptom clusters (psychosocial and physical) for non-oncological and three clusters (psychosocial, physical and communicational/practical) for oncological groups were identified. More patients in the non-oncological group compared to the oncological group showed at least one symptom cluster (83/212; 39.2% vs. 172/566; 30.4%).

CONCLUSION

Patients with non-oncological diseases had shorter episode durations and were more affected by symptom clusters, whereas patients with oncological diseases showed an additional communicational/practical cluster. Our findings indicate the high relevance of care planning as an important part of SPHC to facilitate anticipatory symptom control in both groups.

Symptom Patterns in Young Adults with Cancer: An App-Based Study

OBJECTIVES

To investigate symptom patterns in young adults with cancer using a smartphone-based app. The authors sought to explore symptom frequency and severity, cluster patients based on their symptom severity, investigate the co-occurrence of severe symptoms, and explore the relationship between symptoms and activities.

DATA SOURCES

Data were collected, using a mobile app, from 161 young adults with cancer (mean age 25.5 years, 75% female, 59% with solid cancer). Symptom frequency/severity was investigated with descriptive statistics. K-means clustering technique was used to cluster patients based on the average symptom severity. Co-occurrence of severe symptoms was investigated with the association rule technique. The relationship between symptom severity and likelihood of performing a physical/social activity was explored with mixed-effects logistic regression.

CONCLUSION

The most frequently reported symptom was mood disturbance, followed by fatigue, which was also the most severe one. Two clusters of patients were identified, experiencing higher and lower severity for all symptoms. Severe appetite disturbances were frequently reported together with severe lack of energy and nausea. Severe lack of energy, either alone or together with mood disturbance, was often reported together with severe fatigue. Higher mood disturbance was associated with lower probability of performing physical and social activities. This study provides new insights into the symptom experience of young adults with cancer.

IMPLICATIONS FOR NURSING PRACTICE

Using a symptoms-tracking app may be a valid strategy for healthcare professionals, nurses, and researchers to support patients in symptom monitoring and, consequently, to identify and implement tailored symptom-management strategies.

Survival Prediction of Patients Who Were Terminally Ill Using the EORTC QLQ-C15-PAL Scores and Laboratory Test Values

Background

Prognostics for patients with cancer is especially important for the supportive care of those who are terminally ill. We previously found that symptom scores as patient-reported outcomes (PROs)-such as dyspnea and fatigue scores-some biochemical parameters, the palliative performance scale (PPS) scores, and symptom clusters were useful prognostic factors; however, the predictability of a prognosis based on these factors remains unclear.

Objective

To identify appropriate three-week survival predictive factor(s), in terms of performance, in patients who were terminally ill.

Design

We collected symptom scores as PROs using the Japanese version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care (EORTC QLQ-C15-PAL).

Setting/Subjects

We used data from terminally ill patients with cancer who were hospitalized at the palliative care unit of the Higashisumiyoshi-Morimoto Hospital (Osaka, Japan) from June 2018 to December 2019 (n = 130), as well as additional data obtained from the same clinical study from January to March 2020 (n = 31).

Measurements

To evaluate predictive performance, indices such as sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy were calculated.

Results

We found that the presence of a symptom cluster showed high sensitivity but low specificity and that a higher PPS value (>30) showed high specificity but low sensitivity, suggesting that these factors could provide relevant information for survival prognosis (less than or equal to three weeks).

Conclusion

Symptom clusters obtained from patients is important for effective supportive care of those who are terminally ill.

Patient healthcare experiences of cancer hospitals in China: A multilevel modeling analysis based on a national survey

Importance

Patient satisfaction is a crucial indicator for assessing quality of care in healthcare settings. However, patient satisfaction benchmark for cancer hospitals in China is not established.

Objective

To examine patient satisfaction levels in tertiary cancer hospitals in China, and inter-hospital variations after case-mix adjustment.

Design

A nationwide cross-sectional hospital performance survey conducted from January to March 2021.

Settings

At 30 tertiary cancer hospitals in China.

Participants

A total of 4,847 adult inpatients consecutively recruited at 30 tertiary cancer hospitals were included.

Exposures

Patient characteristics included demographic characteristics (sex, age, education, and annual family income), clinical characteristics (cancer type, cancer stage, self-reported health status, and length of stay), and actual respondents of questionnaire.

Main outcomes and measures

Patient satisfaction was measured using 23 items covering five aspects, administrative process, hospital environment, medical care, symptom management, and overall satisfaction. Responses to each item were recorded using a 5-point Likert scale. Patient satisfaction level for each aspect was described at individual and hospital levels. Using multilevel logistic regression, patient characteristics associated with patient satisfaction were examined as case-mix adjusters and inter-hospital variation were determined.

Results

The satisfaction rates for symptom management, administrative process, hospital environment, overall satisfaction, and medical care aspects were 74.56, 81.70, 84.18, 84.26, and 90.86% with a cut-off value of 4, respectively. Significant predictors of patient satisfaction included sex, age, cancer type, cancer stage, self-reported health status, and actual respondent (representative or patient) (all P < 0.05). The ranking of the hospitals' performance in satisfaction was altered after the case-mix adjustment was made. But even after the adjustment, significant variation in satisfaction among hospitals remained.

Conclusions and relevance

This study pointed to symptom management as a special area, to which a keen attention should be paid by policymakers and hospital administrators. Significant variation in satisfaction among hospitals remained, implying that future studies should examine major factors affecting the variation. In review, target interventions are needed in low-performing hospitals.

An Update on Prevalence, Assessment, and Risk Factors for Sleep Disturbances in Patients with Advanced Cancer—Implications for Health Care Providers and Clinical Research

Simple Summary

This review focuses on sleep in patients with advanced cancer. Cancer patients experience multiple symptoms and they receive concomitant medications. These are all factors that may affect sleep. In this paper, we present recommendations on sleep assessment in patients with advanced cancer and highlight cancer-related factors that may contribute to insomnia. Sleep is an essential aspect of health-related quality of life; therefore, it is important for health care providers to focus on sleep to improve patient care.

Abstract

Patients with advanced cancer experience multiple symptoms, with fluctuating intensity and severity during the disease. They use several medications, including opioids, which may affect sleep. Sleep disturbance is common in cancer patients, decreases the tolerability of other symptoms, and impairs quality of life. Despite its high prevalence and negative impact, poor sleep quality often remains unrecognized and undertreated. Given that sleep is an essential aspect of health-related quality of life, it is important to extend both the knowledge base and awareness among health care providers in this field to improve patient care. In this narrative review, we provide recommendations on sleep assessment in patients with advanced cancer and highlight cancer-related factors that contribute to insomnia. We also present direct implications for health care providers working in palliative care and for future research.