P-151 PRO-based symptom management for patients with gastric and esophageal cancer who have undergone previous surgery

Abstract

The incidence of gastric cancer and esophageal cancer ranks second and third respectively in China. Patients with previously surgically resected gastric and esophageal cancers often suffer from malnutrition, anorexia, gastroesophageal reflux and depression which have a serious implication on their subsequent treatment. However, due to the specificity of the current medical situation in China and the heavy treatment workload of clinicians, there is no efficient and easy way to manage the symptoms of these patients. Patients were randomized in a 1:1 ratio after enrollment into the Patient-Reported Outcome (PRO) symptom management group and the conventional care group. The PRO group were assessed for anorexia, gastroesophageal reflux, depression, nutritional status (assessment scales are FAACT A/CS, GERD-Q, SDS and NRS2002 respectively), weight and BMI in the hospital before each cycle of chemotherapy via an electronic data platform. The doctors responded the assessment results and provided interventions, including advice for home care, drug prescription, and telephone follow-up, before patients are discharged from the hospital. Patients were assessed and managed every 3-4 weeks at the time of return for chemotherapy during 16 weeks. Patients in the usual care group underwent symptom assessment only at the first and the 16th weeks, during which the surgeons only managed the symptoms with usual care modalities. The primary endpoint is number of symptoms at the 16th weeks and the secondary endpoints are the incidence of each symptom at the 16th weeks. From Apr. 2021 to Mar. 2022, 97 pts completed the clinical observation, including 49 pts in the PRO group and 48 pts in the conventional care group. Baseline results of all were not statistically different (P>0.05). After 16 weeks of symptom management, the number of overall symptoms in the PRO group was significantly lower than in the conventional care group (1 (0-1) vs 2.5 (1-4), P < 0.001). The incidence of nutrition risk (24.5% vs 64.6%, P < 0.001), anorexia (24.5% vs 66.7%, P < 0.001), gastroesophageal reflux (12.2% vs 56.3%, P < 0.001) and depression (4.1% vs 16.7%, P=0.042) in the PRO group was significantly lower than that in the conventional care group, and there was no statistically significant difference about underweight (defined: BMI < 18.5, 16.3% vs 33.3%, P=0.052). The NRS2002 (2 [1-2] vs 3 [2-4], P < 0.001), FAACT A/CS (40 [37.5-44] vs 34 [27.3-39.8], P < 0.001), GERD-Q (6 [6-7] vs 8 [6-9], P < 0.001), SDS (32.5 [28.8-37.5] vs 45 [36.6-48.8], P < 0.001) scores of the PRO group were statistically significantly different from those of the conventional group (P < 0.001), while there was no statistical difference in the weight(54.39±8.07 vs 52.06±7.55, P=0.146), BMI (20.45±2.38 vs 19.62±2.44, P=0.095). Of note, although the weight was same, it was found that weight loss was less severe in the PRO group by comparing the weight loss rate (2.04% [-2.97%-3.96%] vs 5.32% [1.84%-9.22%], P < 0.001). Compared to conventional care, the rates of nutritional risk, anorexia, gastroesophageal reflux, depression and weight loss were effectively controlled in patients with previously surgically resected gastric and esophageal cancers through 16 weeks of patient-reported outcome-based symptom management, which providing clinicians with an easy-to-operate and effective means of symptom management.