Patient reported symptom severity in cancer survivors.

Abstract

143 Background: At Stanford Health Care, patient-reported symptom severity is routinely assessed during cancer survivorship visits. Aim: Our objective is to identify the proportion of moderate to severe symptoms reported during first visit by patient group (breast cancer, lymphoma, allogeneic BMT recipients). Methods: Our cohort were unique patients evaluated in a cancer survivorship clinic between 9/1/15 and 8/31/16. Cohort patient report of presence and severity of 23 symptoms using a six-point Likert scale on a paper-based written instrument were collected and analyzed (0 = absent, 1-2 = mild, 3-4 = moderate, 5 = severe). Symptoms include fatigue, pain, constipation, diarrhea, uncontrolled loss of urine, limb swelling, shortness of breath, oral problems, trouble swallowing, muscle weakness, unusual sweating, ability to exercise, numbness in limbs, depression, fear, changes in sleep, body image, skin/hair, appetite, weight, sexual health, cognition and/or balance. Results: 337 unique patients (median age 50, female 64%) were a median of 140 days and mean of 851 days after treatment completion. Overall, the symptoms that have the highest responses in the moderate to severe range (score 3-5) are fatigue (31%), sleep change (23%), memory change (17%), depression (14%) and fear (19%). Breast cancer survivors had similar symptoms overall, but lymphoma survivors reported a higher rate of moderate to severe fatigue (49%), sleep change (38%), memory change (33%) and fear (29%), and the alloBMT group reported a higher rate of moderate to severe fatigue (39%), depression (20%) and fear (25%). Conclusions: Standard use of patient-reported symptom severity assessment shows a high prevalence of moderate to severe physical and psychological symptoms among patients seen in a cancer survivorship clinic. These findings can help focus management on the most prevalent and severe symptoms based on cancer type and time from treatment.