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Frances Wright



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    FP02 - Health Services Research/Health Economics (ID 120)

    • Event: WCLC 2020
    • Type: Posters (Featured)
    • Track: Health Services Research/Health Economics
    • Presentations: 1
    • Moderators:
    • Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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      FP02.10 - Predictors of Moderate-to-Severe Symptoms in Stage IV NSCLC: A Population-Based Study of Patient Reported Outcomes (ID 3525)

      00:00 - 00:00  |  Author(s): Frances Wright

      • Abstract
      • Presentation
      • Slides

      Introduction

      Patients with metastatic NSCLC have significant disease and treatment-related morbidity. In Ontario, Canada, cancer patients complete Edmonton Symptom Assessment System (ESAS) questionnaires, a tool that elicits patients’ self-reported severity of common cancer-associated symptoms at clinical encounters. ESAS domains are: anxiety, depression, drowsiness, appetite, nausea, pain, shortness of breath, tiredness and well-being. The purpose of this study is to examine moderate-to-severe symptom burden in the 12 months following a diagnosis of stage IV NSCLC.

      Methods

      Using administrative databases and unique encoded identifiers, stage IV NSCLC diagnosed between January 2007 and September 2018 were evaluated for symptom screening with ESAS in the 12 months following diagnosis. Proportion of patients reporting moderate-to-severe score (i.e. ESAS ≥4) in each domain within 12 months were calculated. Patients reporting moderate-to-severe within the different ESAS domains of were plotted over time. Multivariable (MV) Poisson regression models with potential covariates such as age, sex, Elixhauser comorbidity index, socioeconomic factors, and cumulative cancer treatments received were constructed to identify factors associated with moderate-to-severe symptoms.

      Results

      Of the 22,799 stage IV NSCLC patients identified, 13,593 (59.6%) had at least 1 completed ESAS recorded (87,791 unique assessments) in the year following diagnosis. Majority (94.6%) reported at least 1 moderate-to-severe score. Tiredness (peak: 67.4%, overall: 84.3%), lack of wellbeing (peak: 62.1%, overall: 80.9%), low appetite (peak: 50.4%, overall: 72.1%), and shortness of breath (peak: 51.0%, overall: 68.1%) were the most prevalent moderate-to-severe symptoms reported by patients within 12 months after diagnosis (these peaked at diagnosis), while nausea (34.92%) was the least common.
      Patients receiving chemotherapy alone (17.5%, n= 2,380), radiotherapy alone (36.3%, n=4,936), or both (24.8%, n=3,369) reported more moderate-to-severe symptoms compared to patients receiving no treatment (risk ratio [RR]: 1.04, 1.04, and 1.06 respectively [all p-values<0.0001). Receiving chemotherapy alone or chemotherapy and radiotherapy combinations was associated with score≥4 in all individual ESAS domains (p-values <0.05), while receiving radiotherapy alone was associated with score≥4 in all domains but shortness of breath (RR: 0.98, p=0.26). Immigrants and patients with worst socioeconomic deprivation index were less likely to report moderate-to-severe symptoms.

      Conclusion

      Moderate-to-severe symptoms were prevalent throughout the first year following stage IV NSCLC diagnosis at the population-level. Patients receiving chemotherapy and/or radiotherapy were at increased risk of moderate-to-severe symptoms and may require more supportive care. Further analyses on predictors of severe-to-moderate score on each ESAS domain will be discussed in the presentation.

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