Abstract
Patient‐reported outcomes regarding symptom burden may provide valuable information in addition to physician assessment. Systematic collection of patient‐reported outcomes may be an important metric to identify unmet needs and improve quality of patient care. To understand common symptoms of patients seen in radiation oncology clinic, we examined the prospectively collected modified Edmonton Symptom Assessment Scale (ESAS‐r) data to explore symptom clusters. Our clinic established use of a modified Edmonton Symptom Assessment Scale in August 2015. All outpatients presenting for radiation oncology services completed the form at each clinic visit. Symptom clusters are defined by two or more symptoms that are interrelated and occur simultaneously with a high degree of predictability. A sample of 916 de‐identified surveys was assessed statistically using principal component analysis (PCA) with varimax rotation to determine independent clustering between the symptoms queried. We found four major clusters of symptoms: Tiredness (tired, drowsiness; PC1), Loss of Appetite (nausea, lack of appetite; PC2), Low Well‐Being (overall & spiritual well‐being; PC3), and Depression (depression, anxiety; PC4). These accounted for 46%, 9.2%, 7.6%, and 7% of total variance, respectively. Internal consistency using Cronbach's alpha was 0.87, 0.7, 0.82, and 0.87, respectively. The most frequent write‐in item was itchiness, present in 24% of the 148 patients responding. Assessment of patients seen in a large radiation oncology clinic revealed several symptom clusters. {Tiredness and drowsiness} represents a major symptom cluster. Itchiness may be underrecognized.
Highlights
There is increasing recognition of the importance of assessing patient-reported symptoms as part of clinical care
Materials and Methods In August 2015, Moffitt Cancer Center introduced a clinical initiative within the Radiation Oncology Department
This project involved distributing patient report forms to each patient being seen in the radiation oncology clinic
Summary
There is increasing recognition of the importance of assessing patient-reported symptoms as part of clinical care. The Edmonton Symptom Assessment Scale (ESAS) and other patient self-report tools have facilitated a growing body of literature regarding symptomatology in palliative care patients, including patients with advanced cancer [3, 4]. As these patients often experience multiple symptoms that affect quality of life and outcomes, recent symptom management literature has focused on identifying and managing symptom clusters [5, 6]. A commonly applied definition of symptom cluster is two or Patient-R eported Symptom Clusters more symptoms that are interrelated and occur simultaneously with a high degree of predictability [7, 8]
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