Integrating PROs with prognostic value into oncologic care: High ESAS global distress score associated with lower overall survival in advanced cancer patients.

Abstract

12021 Background: Despite compelling data supporting their use, patient reported outcomes (PROs) are not widely integrated into routine cancer care. In our Palliative Care (PC) practice, all patients complete the Edmonton Symptom Assessment Scale (ESAS), a simple, validated 10-item PRO tool which uses a 0 to 10 rating of 10 common symptoms (pain, fatigue, nausea, drowsiness, appetite, sleep, dyspnea, well-being, anxiety & depression). Our team has previously validated the Global Distress Score (GDS), a sum of 9 physical + psychosocial ESAS items. Here, we studied the implementation of the GDS as a streamlined way to capture the overall symptom burden while providing prognostic value. Methods: We queried a PC database for patients w metastatic cancer at time of 1st PC visit. GDS was calculated & grouped into 3 cohorts based on previous work & clinical experience: high (GDS of 35+), Moderate (16-34) or Low (0-15). Overall Survival was defined as time from 1st PC visit date to death. Regression analysis, ANOVA and t-tests were conducted. Results: 333 patients met the inclusion criteria: median age 62.4y (range 20.5-88.4y), 25 AYA (15-39y), 169 mid age (35-64y), 140 seniors (65y+); 190 female 143 male; median prior therapies 2 (range 0-11), 227 patients were in 2nd line + above therapy. Median ECOG PS 2; 124 patients w ECOG PS 3 & 33 w ECOG PS 4. 262 patients had died at time of analysis. Lower OS was associated w higher GDS (r 0.21, P < 0.001). OS in Low, Mod, High GDS cohorts was 13.1m, 7.9m, & 3.7m, respectively (p < 0.001). There were no sig OS difference between 3 age cohorts (AYA 5.2m, mid age 6m, seniors 5.4m, p0.56). Conclusions: Higher GDS score was associated with a clinically significant decrease in overall survival highlighting the potential of the ESAS as a PRO tool in prognostication and clinical decision making for patients with advanced cancers with a high symptom burden. In the realm of increasingly complex PRO instruments, the ESAS represents a simple, well-validated tool which, in our studies and 25 years of clinical experience, takes the patient less than a minute to complete, with subscores such as the GDS which carry a highly prognostic utility for patients with advanced cancers.