Differences In Symptom Burden Research Articles

#2891 Comparing health-related quality of life and symptom burden in patients undergoing twice-weekly versus thrice-weekly haemodialysis

Abstract Background and Aims Patients with kidney failure who initiate haemodialysis (HD) have traditionally followed a thrice-weekly, 4-hour schedule. Recently, incremental dialysis (i.e. initiating HD with lower frequency and/or treatment duration) has been advocated. It has been suggested that residual kidney function is better preserved, while mortality is similar when initiating dialysis with a twice versus thrice weekly schedule. It remains unclear which impact initiating dialysis twice a week has on health-related quality of life (HRQoL) in the short and long term. Therefore, the aim of this study was first to investigate the impact of following a twice-weekly dialysis schedule on the mental and physical HRQoL and symptom burden compared to thrice-weekly dialysis during the first year of dialysis. Second, to investigate the long term impact on mental and physical HRQoL and symptom burden of patients who solely started on a twice-weekly versus thrice-weekly schedule. Method Data were obtained from the ongoing multicentre, prospective, observational Dutch nOcturnal and hoME dialysis Study To Improve Clinical Outcomes (DOMESTICO). This study longitudinally compares HRQoL between home and in-center dialysis. For this analysis, incident HD patients > 18 years were included, if they started on a twice-weekly or thrice-weekly schedule. Mental and physical HRQoL was measured using the validated 12-item Short Form Health Survey (SF12, summary scores ranging from 0 to 100). Symptom burden was measured using the dialysis symptom index (DSI), consisting of 30 items on dialysis-related symptoms, these symptoms are reported using a 5-point Likert scale. The overall burden score, ranging from 0 to 150, was calculated by summing every symptom and its severity. The first aim was longitudinally analysed using linear mixed models, using measures at 3, 6 and 12 months after start dialysis. The second aim was cross-sectionally analysed at 1, 2 and 3 years after dialysis initiation using linear regression models. All models were adjusted for possible confounders. Results A total of 1007 patients were included, of whom 205 started on a twice-weekly schedule and 802 on a thrice-weekly schedule. The total population had a mean age of 64 ± 15 years and 35% were women. There was no significant difference in baseline characteristics between twice-weekly and thrice-weekly dialysis. At baseline mental and physical HRQoL for patients on twice-weekly dialysis were 45.9 ± 9.5 and 36.0 ± 10.7, respectively. In thrice-weekly dialysis this was 45.8 ± 10.3 and 35.0 ± 9.7. The symptom burden score at baseline was 33.0 ± 19.6 for twice-weekly and 34.0 ± 21.7 for thrice-weekly patients. As shown in Table 1, there were no significant differences in HRQoL or symptom burden over the first year of dialysis when comparing twice-weekly with thrice weekly HD. In Table 2 the long-term cross-sectional analyses show that starting with a twice-weekly schedule results in physical and mental HRQoL scores gradually becoming lower, with a statistically significant decrease in physical HRQoL score at 3 years after start dialysis (ß = −0.825, 95% CI −14.11; −2.38). There was no significant difference in symptom burden between the two schedules. Conclusion We found no differences in HRQoL or symptom burden during the first year of dialysis comparing incident patients on a twice-weekly versus thrice-weekly hemodialysis schedule. Conversely, starting on a twice-weekly dialysis schedule appears to be associated with a lower HRQoL, especially physical HRQoL, in the longer term. Following our results, physicians should be cautious of the possible negative effects on HRQoL when prescribing a twice-weekly dialysis schedule.

The GUTFIT Cohort: Understanding of different gastrointestinal symptoms score variation between Chinese and non-Chinese individuals with functional constipation

The diagnosis of functional constipation (FC) relies on patient-reported outcomes evaluated as criteria based on the clustering of symptoms. Although the ROME IV criteria for FC diagnosis is relevant for a multicultural population(1), how an individual’s lifestyle, environment and culture may influence the pathophysiology of FC remains a gap in our knowledge. Building on insights into mechanisms underpinning disorders of gut-brain interactions (formerly functional gastrointestinal disorders) in the COMFORT Cohort(2), this study aimed to investigate the differences in gastrointestinal (GI) symptom scores among participants with FC in comparison to healthy controls between Chinese and non-Chinese New Zealanders. The Gastrointestinal Understanding of Functional Constipation In an Urban Chinese and Urban non-Chinese New Zealander Cohort (GUTFIT) study was a longitudinal cohort study, which aimed to determine a comprehensive profile of characteristics and biological markers of FC between Chinese and non-Chinese New Zealanders. Chinese (classified according to maternal and paternal ethnicity) or non-Chinese (mixed ethnicities) adults living in Auckland classified as with or without FC based on ROME IV were enrolled. Monthly assessment (for 3 months) of GI symptoms, anthropometry, quality of life, diet, and biological samples were assessed monthly over March to June 2023. Demographics were obtained through a self-reported questionnaires and GI symptoms were assessed using the Gastrointestinal Symptom Rating Scale (GSRS) and Structured Assessment of Gastrointestinal Symptoms Scale (SAGIS). This analysis is a cross-sectional assessment of patient-reported outcomes of GI symptoms. Of 78 enrolled participants, 66 completed the study (male, n = 10; female, n = 56) and were distributed across: Chinese with FC (Ch-FC; n = 11), Chinese control (Ch-CON; n = 19), non-Chinese with FC (NCh-FC; n = 16), non-Chinese control (NCh-CON; n = 20). Mean (SD) age, body mass index, and waist circumference were 40 ± 9 years, 22.7 ± 2.5 kg/m2, and 78.0 ± 7.6 cm, respectively. Ethnicity did not impact SAGIS domain scores for GI symptoms (Ethnicity x FC severity interaction p>0.05). Yet, the constipation symptoms domain of the GSRS was scored differently depending on ethnicity and FC status (Ethnicity x FC interaction p<0.05). In post hoc comparison, NCh-FC tended to have higher GSRS constipation severity scores than Ch-FC (3.4 ± 1.0 versus 3.8 ± 0.8 /8, p<0.1) Although constipation symptom severity tended to be higher in NCh-FC, on the whole, ethnicity did not explain variation in this cohort. FC status was a more important predictor of GI symptoms scores. Future research will assess differences in symptom burden to explore ethnicity-specific characteristics of FC.

Symptom burden and relief in palliative care units of German Comprehensive Cancer Center and other hospitals

PurposeThe National Hospice and Palliative Registry contains patient data from German hospice and palliative care facilities about symptoms. The aim of the study at hand is to differentiate symptom burden of patients in palliative care units between Comprehensive Cancer Center (CCC) and other hospitals regarding symptom burden and relief of patients in palliative care units.MethodsThe registry analysis provided data of patients in palliative care units (2014–2018). We analyzed characteristic and symptom-related data on 18 symptoms, with considerable symptom-burdened patients (moderate or severe). We followed a cancer (yes/no) and facility-specific descriptive analysis (f, %, μ, Mdn, SD, V, r) using SPSS.ResultsWe evaluated 10,447 patient records (CCC: 4234 pts/non CCC 6,213 pts), 82% with a cancer diagnosis. For cancer patients, the mean age in CCC-affiliated palliative care units was 68 (SD 19–99) years, in others 73 (SD 23–104) years (p < 0.05; V = 0.2). The proportion of patients with significant symptom burden is lower in CCC-affiliated than in other palliative care units. The difference between facilities shows a significant weak effect in pain, vomiting and constipation, depressiveness, anxiety, and tension. The proportion of cases which symptom burden could be alleviated is higher in CCC-affiliated palliative care units with significant weak/medium effect in pain, nausea, vomiting, shortness of breath, constipation, wound care problems, depressiveness, anxiety, tension, confusion, and problems in organizing care.ConclusionWe found differences in symptom burden and symptom relief between CCC-affiliated and other palliative care units. CCCs should continue to feel responsible for sharing knowledge about symptom relief, such as through standard operating procedures and education.

Abstract 4836: Race differences in symptom burden and medication adherence among women with breast cancer on adjuvant endocrine therapy: A post hoc analysis of a randomized control trial

Abstract Background: Adjuvant endocrine therapy (AET) reduces breast cancer recurrence, but racial differences in nonadherence remains a concern. Differential symptom burden may contribute to disparities in AET adherence. Method: We conducted a post hoc analysis by race among women with breast cancer starting AET who were randomized in THRIVE Study (NCT03592771) to investigate remote symptom monitoring intervention vs. usual care from 11/2018 to 06/2021. Participants completed surveys at baseline, 6- and 12-month. Outcomes were symptom burden measured by FACT-Endocrine Subscale, and adherence measured by electronically monitored pillbox (&amp;gt;80% Proportion of Days Covered). We estimated symptom differences by race using linear regression with and without adjusting for baseline characteristics. To examine whether symptom burden contributed to racial differences in adherence, we conducted multivariable regression for adherence with and without controlling for symptom burden, and Blinder-Oaxaca decomposition. Results: Among 102 (34%) Black and 194 (66%) White women who were randomized, retention was 88% at 12-month. Compared to White participants, Black participants were younger (55 vs. 60 years), more likely to be at poverty (10.8% vs. 4.1%), and had lower health literacy (18.9% vs. 13.4%; p-values&amp;lt;.01). While symptom burden did not differ by study arm, Black participants had worse symptoms than White at baseline (60.8 vs. 64.5, p=.002). This gap became smaller at 6-month (59.7 vs. 61.2, p=.30), but diverged again at 12-month (56.9 vs. 61.8, p&amp;lt;0.01). Differences at 12-month diminished after controlling for baseline characteristics (-1.6, 95%CI=-4.4 to 1.2). Notably, being at poverty and younger age were associated with higher symptoms. Adherence was lower among Black participants at 6-month (0.69 vs. 0.78, p=.13) and 12-month (0.44 vs. 0.60, p=.014) than White participants. Unadjusted differences in adherence at 12-month (-16.0 percentage points [ppts], 95%CI=-28.9 to -3.3, p=.01) attenuated after adjusting for baseline symptoms, symptom changes to 12-month, and other baseline characteristics (-10.4 ppts, 95%CI=-25.6 to 4.8, p=.18). Lower baseline symptoms were associated with better adherence (0.8 ppts, 95%CI=0.1 to 1.4, p=.03). Decomposition indicates that 9.1 ppts (95%CI=-4.8 to 23.0, 57%) of the difference in 12-month adherence was explained by symptoms and baseline characteristics, and remaining unexplained difference was 6.9 ppts (95%CI=-12.6 to 26.4, 43%). Conclusion: Our results add to increasing evidence that Black women with breast cancer have lower AET adherence, which may be partially attributed to worse symptoms than White women. These results highlight the need for new strategies to promote equitable symptom management and adherence strategies between Black and White women to reduce disparities in outcomes. Citation Format: Xin Hu, Rebecca A. Krukowski, Ed Stepanski, Lee S. Schwartzberg, Gregory A. Vidal, Ilana Graetz. Race differences in symptom burden and medication adherence among women with breast cancer on adjuvant endocrine therapy: A post hoc analysis of a randomized control trial [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4836.

Abstract 2135: Racial disparities in symptom burden among women receiving early stage breast cancer chemotherapy

Abstract Purpose: The purpose of this study was to compare prevalent symptoms (pain, fatigue, and physical function) and changes over time between Black and White women undergoing chemotherapy for early-stage breast cancer (ESBC) employing a longitudinal, repeated measures design over the course of ESBC. Methods: Data collected as per protocol of 1R01MD012245, comparing racial differences in chemotherapy tolerance and dose modifications during chemotherapy treatment at baseline, midpoint, and endpoint, tailored to each patient's individual chemotherapy schedule. Race was collected by patient self-report and chart review. Symptom burden (fatigue, pain, and physical functioning) was measured by the PROMIS-29 Profile v 2.0). Area deprivation was measured using the Area Deprivation Index (ADI). Linear mixed models were used to assess racial differences in symptom burden across timepoints, and changes in symptom burden over time, adjusting for ADI. Results: A total of 147 patients participated in this study (36% Black and 64% white). Pain: Black patients reported significantly higher pain scores than White patients at pretherapy (MD=3.7, p=.034), midpoint (MD=5.8, p: 0.002), and endpoint (MD=7.8, p&amp;lt;.001). Even after adjusting for area deprivation, this disparity persisted (F(1, 390)=29.43, p&amp;lt;.001), with Black patients having higher pain scores at midpoint (MD=4.7, p: 0.02) and endpoint (MD=7.8, p&amp;lt;.001). Pain scores worsened over time for Black patients, increasing significantly by the end of chemotherapy (MDT1-T3 =6.2, p=.010; MDT2-T3=5.8, p=.024). No significant changes in pain scores were observed over time among White patients. Fatigue: After adjusting for area deprivation, fatigue significantly increased at the endpoint (MDT1-T3=8.9, p&amp;lt;.001) for Black patients. Among White patients, fatigue increased at midpoint (MDT1-T2=5.7) and continued to worsen at the endpoint (MDT1-T3=10.1, p&amp;lt;.001; MDT2-T3=4.3, p=.017). Physical Function: Black patients had significantly lower physical function than White patients at the midpoint (MD=4.0, p=.027). By the end of chemotherapy, physical function deteriorated significantly for Black patients (MDT1-T3=7.8, p&amp;lt;.001), and White patients (MDT1-T3=7.7, p&amp;lt;.001; MDT2-T3=4.8, p=.002). Correlations between the ADI and symptom severity and physical function revealed that living in more deprived areas was associated with greater pain severity (r=-.227, p=.002, 56.3 vs. 50.1) and worse physical function (r=-.190, p=-.035, 40.6 vs. 42.4) at the completion of chemotherapy. Conclusions: The findings indicate that race and area deprivation are associated with symptom trajectories over the course of ESBC chemotherapy. Further research is warranted on how to best assess and relieve symptom burden among Black ESBC patients so that existing disparities in treatment and treatment outcomes are not perpetuated. Citation Format: Elham Nasrollahi, Hiba Abujaradeh, Susan Mazanec, Julia O'Brien, Isabelle M. Schlemmer, Margaret Rosenzweig. Racial disparities in symptom burden among women receiving early stage breast cancer chemotherapy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2135.

Gender differences in symptom burden among people living with HIV/AIDS receiving antiretroviral therapy in Yunnan, China

ABSTRACT Little is known about gender differences in the symptom burden of people living with HIV/AIDS (PLWHA) on antiretroviral therapy in China. This study was conducted based on a biopsychosocial-medical model to describe gender differences in symptom burden among 1035 PLWHA in Yunnan Province, China. After propensity score matching, 798 PLWHA were included in this analysis. Feeling stressed, poor sleep, and memory loss were the most burdensome symptoms among men, while feeling stressed, memory loss, and dizziness were the most burdensome symptoms among women. Among men PLWHA, factors associated with symptom burden were being of the ethnic minority, CD4 count ≥ 500 cells/mm3, physical functioning, and social support. Among women PLWHA, factors associated with symptom burden were being an inpatient, physical functioning, psychological functioning, and social support. Our findings suggest that healthcare providers need to take into account gender differences when developing optimal prevention, treatment, and care programs that provide individualized care to reduce patients’ symptom burden.

Abstract B052: Associations of cancer patients' sociodemographic characteristics with cannabis-related behaviors

Abstract Background: Medical and non-medical cannabis is increasingly legalized and popularized in the US, yet there is a paucity of research on the subject, particularly in a cancer context. Previous research examining correlates of sociodemographic characteristics with cannabis-related behaviors are limited to gender-specific comparisons. In the present study, we examined how these behaviors by adults with cancer differed by age, gender, race, educational attainment, and cancer type. Methods: 943 patients attending any of 8 Ohio State University Comprehensive Cancer Center clinics were recruited in person (n=721) or remotely (n=222) into an anonymous cross-sectional study. Eligible patients were ≥18 years of age and were diagnosed with invasive cancer (all stages) in the past 12 months. Participants self-administered a validated, extensive cannabis-focused questionnaire, which queried on cannabis-related behaviors and use, along with demographic and clinical information. Descriptive statistics, chi-square tests, and multivariable logistic regressions were used to examine associations between cannabis-related behaviors and sociodemographic factors and cancer type. Results: Participants were, on average, 61.7 ± 12.1 years old with at least some college education (70.4%). Older participants, aged ≥ 63 years, were less likely to be currently using cannabis (OR=0.27, 95% CI: 0.17-0.43; P&amp;lt;0.001) and less likely to be interested in cannabis (OR=0.60, 95% CI: 0.43-0.82; P=0.001) than younger participants. Participants with at least a 4-year college degree were less likely to be currently using cannabis (OR=0.48, 95% CI: 0.28-0.84, P=0.009) and less likely to have received a provider recommendation of cannabis use compared to the least educated (OR=0.31, 95% CI: 0.14-0.72, P=0.006). Patients with skin cancer were less likely to be currently using cannabis compared to those with lung cancer (OR=0.26, 95% CI: 0.07-0.92; P=0.037). Conclusions: Multiple factors (e.g., age, educational attainment) were associated with differences in cannabis-related behaviors among cancer patients. Results indicate that differences by sociodemographic characteristics exist, which may be associated with differences in symptom burden, patient-provider interactions, and other health behaviors. These results add to a burgeoning area of research and provide insight for future research and clinical inquiry related to cannabis use among cancer patients. Citation Format: Neema C. Adley, Jessica L. Krok-Schoen, Theodore M. Brasky, Jesse J. Plascak, Alison M. Newton, Anita Adib. Associations of cancer patients' sociodemographic characteristics with cannabis-related behaviors [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B052.

P175: Cohort differences in depressive burden in old age: role of psychosocial, behavioral, and functional factors

Objective:Rapid societal changes occurred during the course of the 20th century. Previous literature has found an increase in depression over time for younger and middle- aged populations. Among older adults, the prevalence of major depression has been found to be stable over time, while for the milder forms, the findings are limited by the largely non-representative nature of analyzed samples. Given the dramatic secular changes in several factors linked to old-age depression, a careful examination of depressive symptom burden and prevalence of depression in representative cohorts of similarly-aged older adults separated in time is required.Methods:We will analyze data on 2,041 older adults from the Swedish National Study on Aging and Care in Kungsholmen. Separate individuals, aged 60 and 81 years were assessed with a Comprehensive Psychopathological Rating Scale (CPRS) during detailed clinical examinations, separated in time by 15 years (2001 vs. 2016). Information on 21 depressive symptoms, is subsequently combined into diagnoses of major depression (presence of at least one core symptom [low mood and/or loss of interest], and at least five out of the nine symptoms); minor depression (presence of at least one core symptom, and two to four symptoms in total), and subsyndromal depression (presence of at least two symptoms in the absence of any other depression diagnoses). Psychosocial (loneliness, bereavement), behavioral (alcohol consumption, smoking), and functional factors (impairments in activities of daily living) are used as potential explanatory factors for any observed cohort differences in symptom burden or prevalence of depression.Results:For the 60-year old age-group, comparison of symptom burden and diagnostic status will be done across 739 participants assessed in 2001 and 677 people assessed in 2013. For the 81-year old age- group, comparisons will involve 236 people assessed in 2001, 194 people assessed in 2010, and 195 people assessed in 2016.Conclusion:Preliminary results are expected by March, once data entry and cleaning are completed. We hypothesize that the burden of depressive symptoms and the prevalence of depression will be lower in later born cohorts and that explanatory factors may account for some of the cohort effect.

Differences in Symptom Burden in Primary Brain Tumor Patients Based on Sex, Race, and Ethnicity: a Single-Center Retrospective Study.

Symptom burden affects quality of life and prognosis in primary brain tumor (PBT) patients. Knowing whether symptom burden varies based on sex, race, or ethnicity may affect the interpretation of the relationship between symptoms and survival may reveal issues with applying the tools to measure symptom burden to different groups and may identify inequities in symptom management that need to be addressed at a system level. To determine whether symptoms in PBT patients vary across demographic groups, we conducted a retrospective chart review of symptom burden collected as part of routine care in a diverse population. Patient demographics and scores on the MD Anderson Symptom Inventory-Brain Tumor (MDASI-BT) module were extracted from the electronic medical record for patients seen in the Inova Neuro-oncology Clinic between March 2021 and June 2022. MDASI-BT scores were compared based on side of tumor, sex, race, and ethnicity for the entire population and for the subset with gliomas. We included 125 people, of whom 85 had gliomas. For both the entire group and the subgroup with gliomas, about 40% were female and about 40% were non-White race. No differences in symptom burden were seen between males and females. Pain and numbness/tingling symptom burden were higher in both the entire population and the glioma subgroup for people of Hispanic/Latino/Spanish ethnicity and for people of races other than White or Middle Eastern self-identification. Pain, weakness, and numbness/tingling varied significantly across racial and ethnic groups. Further research is needed to validate this finding in other populations and determine its cause.

Motor neurone disease: A point-prevalence study of patient reported symptom prevalence, severity and palliative care needs.

Motor neurone disease is a rare but debilitating illness with incomplete evidence regarding patients' symptom burden. Palliative care and generalist clinicians are often in-experienced in caring for these patients and assessing their needs. To identify the symptom prevalence and severity experienced by patients with motor neurone disease. Secondary objectives were to examine differences in symptom burden and clusters according to phenotype, functional status, palliative care provision and those in their last months of life. A point prevalence study assessing patient-reported symptoms using a modified IPOS-Neuro assessment tool, incorporating 41 symptom items. Patients with motor neurone disease attending the State-wide Progressive Neurological Disease Service or inpatient unit at Calvary Health Care Bethlehem, Melbourne Australia, from March to December 2021. A total of 102 patients participated, the majority diagnosed with lumber-onset (30.4%), bulbar-onset (28.4%) and cervical-onset (25.5%) phenotypes. Patients experienced a median of 17 symptoms (range 2-32) with a median of 3 symptoms rated as severe/overwhelming (range 0-13). Motor and functional symptoms predominated, with differences in symptom clusters present according to phenotype. Patients had a higher number of severe/overwhelming symptoms if they were accessing palliative care services (p = 0.005), in their last 6 months of life (p = 0.003) and experiencing moderate or severe functional impairment (p < 0.001). Patients with motor neurone disease report high symptom burden. A validated motor neurone disease-specific symptom assessment tool is needed to accurately assess patients, including important variations in symptom clusters according to phenotype. Further research must focus on evidence-based treatment guidelines for symptoms experienced commonly and severely.

Correlates of Rates and Treatment Readiness for Depressive Symptoms, Pain, and Fatigue in Hemodialysis Patients: Results from the TĀCcare Study.

Patients on hemodialysis (HD) often experience clinically significant levels of pain, fatigue, and depressive symptoms. We explored potential sociodemographic differences in symptom burden, current treatment, and readiness to seek treatment for these symptoms in patients screened for the TĀCcare trial. In-center HD patients from Pennsylvania and New Mexico were screened for fatigue (≥5 on 0 to10-point Likert scale), pain (Likert scale ≥4), depressive symptoms (≥10 Patient Health Questionnaire-9) and readiness to seek treatment (5-item Stages of Behavior Change questionnaire). Symptom burden and treatment status by sociodemographic factors were evaluated using chi-square, Fisher's exact tests, and logistic regression models. From March 2018-Dec 2021, 506 of 896 (57%) patients screened met eligibility criteria and completed the symptom screening (mean age 60±13.9 years, 44% females, 17% Black, 25% American Indian, 25% Hispanics). Of these, 77% screened positive for ≥1 symptom and 35% of those were receiving treatment for ≥1 of these symptoms. Pain, fatigue, and depressive symptom rates were 52%, 64%, and 24%, respectively. Age <65 was associated with a higher burden of depressive symptoms, pain, and reporting ≥1 symptom (p<0.05). The percentage of patients ready to seek treatment increased with symptom burden. More males reported readiness to seek treatment (85% vs. 68% of females, p<0.001). Among those with symptoms and treatment readiness, income was inversely associated with pain (>$60k/yr: OR=0.16, CI=0.03-0.76), and living in less walkable neighborhoods with more depressive symptoms (OR= 5.34, CI=1.19-24.05) and fatigue (OR= 5.29, CI=1.38-20.33). Pain, fatigue, and depressive symptoms often occurred together, and younger age, less neighborhood walkability, and lower income were associated with a higher burden of symptoms in HD patients. Male patients were less likely to be receiving treatment for symptoms. These findings could inform priority HD patient symptom identification and treatment targets.

P093 Clinical outcomes and care quality standards in young adult patients with early inflammatory arthritis: Results from a national cohort

Abstract Background/Aims Emerging adulthood is a unique developmental period between late adolescence and establishment of personal and social identity associated with adulthood. Emerging adult populations may have distinctive experiences of adult healthcare and their needs may differ from those of older healthcare users. Little is known about the patterns of presentation, experiences of care or disease outcomes of emerging adults in adult rheumatology settings. We used the National Early Inflammatory Arthritis Audit (NEIAA) to describe differences between emerging and older adult patients diagnosed with early inflammatory arthritis (EIA). Methods NEIAA is an observational cohort design study assessing care against National Institute for Health and Clinical Excellence quality metrics. Adults in England and Wales with a confirmed new diagnosis of inflammatory arthritis between May 2018 and April 2022 were grouped into two categories: emerging adults (16-24 years) and older patients (≥25 years). Patient characteristics, disease phenotype (including oligo- or polyarticular presentation) and initial treatment strategy were described. Results A total of 20,472 patients were included. 571 (2.8%) diagnosed with EIA were emerging adults (EA); this group had higher proportions of females (71.8%). Compared to older patients, EA patients were less likely to ever smoke (44.1% vs 69.5%) and had fewer comorbidities. EA patients were more likely to have oligoarticular symptoms (&amp;lt;5 tender and swollen joints; 53% vs 37%). Symptom duration prior to diagnosis was longer for EA patients (46% describing symptom duration &amp;gt;6 months vs 37%). Median Disease Activity Score/DAS28 at presentation was lower (4.2 vs 4.7). There were no differences in symptom burden as measured by the mean musculoskeletal health questionnaire (25 vs 24). EA patients completed fewer patient reported outcomes (33% vs 39%), but were more likely to complete all forms (20% vs 17%). Disease modifying anti-rheumatic drugs treatment strategies appeared similar, although more EA patients did not start medications by three months (26% vs 19%). Fewer EA patients received steroids (56% vs 71%).There were no significant differences between groups in patient numbers referred within three days of symptom onset from primary care or reviewed within three weeks with treatment initiation within six weeks in rheumatology care. More of the EA group were in employment at diagnosis. The EA population reported higher impairment at work (Work Productivity and Activity Index overall score 38% vs 30%, driven by difference in presenteeism). Conclusion Low proportion of EA patients in this EIA population raises concern that the study is not capturing a representative sample of this younger and developmentally distinct population. Available data suggest important differences in time to presentation, disease pattern and pathways of care between EA and older patients. EA population deserves further detailed investigation, exploring frequency and patterns of EIA and identifying particular issues faced when using adult rheumatology services. Disclosure M. Adas: None. N. Arumalla: None. D. Mclaughlin: None. J. Galloway: Honoraria; from AbbVie, Celgene, Chugai, Galapagos, Gilead, Janssen, Lilly, Pfizer, Roche and UCB. J. Ledingham: Other; is a BSR trustee. F. Mcerlane: None.

Career stage differences in mental health symptom burden and help seeking among veterinarians during COVID-19.

To explore veterinarians' mental health symptom burden during COVID-19 and identify differences in symptom burden, social support, help seeking, and incentives and barriers associated with receiving help across career stages. Online survey responses from 266 veterinarians between June 4 and September 8, 2021. Respondents were grouped by career stage (early [< 5 years of experience], middle [5 to 19 years of experience], or late [≥ 20 years of experience]), and results were compared across groups. Of the 262 respondents who reported years of experience, 26 (9.9%) were early career, 130 (49.6%) were midcareer, and 106 (40.4%) were late career. The overall mean anxiety and depression symptom burden score was 3.85 ± 3.47 (0 to 2 = normal; 3 to 5 = mild; 6 to 8 = moderate; and 9 to 12 = severe), with 62 of 220 (28.1%) respondents reporting moderate to severe symptom burden. Most (164/206 [79.6%]) reported not accessing behavioral health providers, and of these, 53.6% (88/164) reported at least mild symptom burden. There were significant differences in both symptom burden and mental health help-seeking intentions across career stages, with early- and midcareer (vs late-career) veterinarians reporting higher symptom burden (P = .002) and midcareer (vs late-career) veterinarians reporting higher help-seeking intentions (P = .006). Barriers and incentives for seeking mental health care were identified. Findings revealed differences in symptom burden and intentions to seek mental health care across veterinary career stages. Incentives and barriers identified serve to explain these career stage differences.

Is Disease Response a Patient-Centered Clinical Trial Endpoint in Acute Myeloid Leukemia: Differences in Symptom Burden and Physical Function By Response Status in the Beat-AML Master Trial

Objective: To inform regulatory decision making about trial design and drug approval, we examined whether disease response status is a patient-centered endpoint in therapeutic trials for acute myeloid leukemia (AML). Specifically, we estimated the association of response status with patient-reported symptoms and physical function in the Beat-AML Master Trial. Methods: The Beat-AML Master Trial (NCT03013998) is composed of a genomic screening protocol and multiple sub-studies of biomarker-based treatments for sub-types of acute myeloid leukemia. The patient-reported outcome (PRO) assessment occurred at baseline and at specified study visits about once per cycle depending on treatment phase. The PRO assessment included the MD Anderson Symptom Inventory (MDASI) AML/MDS symptom scale (17 items), additional symptom items from the MDASI library relevant to Beat-AML therapies (10 items), and the PROMIS® Physical Function short form (6 items). The two symptom scale scores range from 0-10 where higher scores indicate greater symptom burden; the physical function scale score ranges from 0-100 where higher scores indicate better physical function. Disease response was assessed according to 2017 ELN AML Recommendations, including: complete remission (CR), complete remission without minimal residual disease (CRMRD-), complete remission with hematologic improvement (CRh), complete remission with incomplete blood count recovery (CRi), morphological leukemia free state (MLFS), partial remission (PR), stable disease, progressive disease, recurrence/relapse, and treatment failure. For this analysis, response status was identified for each PRO assessment timepoint. Linear mixed effects models estimated the differences in PRO scores between each response status and CR. The analytic sample was composed of individuals who completed the baseline PRO assessment and at least one PRO assessment post baseline. The minimally important difference (MID) for the PROMIS Physical Function scale is 4 points (Yost, J Clin Epi 2012). The symptom scales do not have established MID, so coefficients were compared to a small effect size (0.20) per Cohen's d. Results: The analytic sample included 240 patients from 11 Beat-AML sub-studies; the median age was 73 years (range: 42-90) and 42.5% were female. Median follow-up time with PRO assessments was 18.4 months. The survey response rate was 80.7%. The mean (standard deviation) PRO scale scores at baseline were: 2.11 (1.67) AML/MDS symptom scale, 1.54(1.54) additional symptoms, and 36.65(9.62) Physical Function. The proportion of patients achieving each response at any point during protocol treatment was 32.1% CR, 7.5% CRMRD-, 6.7% CRh, 23.3% CRi, 19.6% MLFS, 5.8% PR, 73.3% stable disease, 11.7% progressive disease, 20.0% recurrence/relapse, and 7.5% treatment failure, for an average of 2.4 responses per patient. After controlling for age, gender, treatment (sub-study), time since baseline, and adjusting for drop-out missingness, we found that, compared to CR, symptom burden was greater for MLFS and stable disease (coefficient range 0.33 to 0.66) (see Table 1). Symptom burden per the AML/MDS scale only was also greater for recurrence/relapse (coef. 0.49). Physical function was worse (per MID) for MLFS, stable disease, and progressive disease (coefficient range: -4.42 to -4.76). Discussion: PRO data from 11 sub-studies of the Beat AML Master Trial indicate key differences and similarities between disease response statuses in terms of symptom burden and physical function. MLFS was the only type of response that differed from CR with respect to symptom burden and physical function. Stable disease and recurrence/relapse were associated with greater symptom burden than CR, but progressive disease was not, however it was associated with worse physical function. Findings regarding treatment failure may be limited by small sample and wide range of health within that status. Sensitivity analyses will include removing rare symptoms from the symptom scales, which may increase model coefficients. Subsequent analysis will examine the association of the patient's best response status with long term physical function. Conclusion: Further research is warranted to establish the response statuses of CRMRD-, CRh, CRi, and partial remission as clinical trial endpoints that are valuable to patients with respect to health-related quality of life. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Symptom dimensions of anxiety and depression in patients receiving peritoneal dialysis compared to haemodialysis

Differences in symptom burden, treatment satisfaction and autonomy between patients receiving peritoneal dialysis and haemodialysis could be reflected by a difference in symptom dimensions of anxiety and depression. The aim of this study is to assess differences in prevalence and symptom dimensions of anxiety and depression between patients receiving peritoneal dialysis and haemodialysis. Baseline data from the Depression Related Factors and Outcomes in Dialysis Patients With Various Ethnicities and Races Study were used. Symptoms of anxiety and depression were measured with the Beck Anxiety Inventory and Beck Depression Inventory- second edition. Linear and logistic regression models were used to compare anxiety and depression total scores and somatic and subjective/cognitive symptom dimension scores between patients receiving peritoneal dialysis and haemodialysis, adjusted for potential confounders. In total, 84 patients receiving peritoneal dialysis and 601 patients receiving haemodialysis were included. Clinically significant symptoms of anxiety and depression were present in respectively 22% and 43% of the patients, with no differences between dialysis modality. Both modalities scored high on the somatic symptom dimensions and on individual somatic items. Almost all patients reported symptoms related to loss of energy and sleep. No differences in symptom dimensions of anxiety and depression were found between patients receiving peritoneal dialysis and haemodialysis. The high prevalence of somatic symptom dimensions in both groups underscores the possible interaction between somatic and psychiatric symptoms in dialysis patients and the need for early recognition and treatment of symptoms of anxiety and depression regardless of treatment modalities.

A Multivariable Analysis to Evaluate the Presence or Absence of Gender Differences in Baseline ImPACT Composite Scores and Symptom Severity Ratings in Student-Athletes Ages 12-18Years.

Gender differences in neurocognitive function have been reported over the past few decades. However, multiple studies that report gender differences in Immediate Post-Concussion Assessment and Cognitive Tests composite scores ignore potential confounders which may lead to inaccurate results. A total of 4829 male and 2477 female baseline Immediate Post-Concussion Assessment and Cognitive Tests from 2009 to 2019 of subjects ages 12-18years were used to evaluate gender differences in baseline neurocognitive scores and symptom severity ratings. Regression analyses were used to assess the effects of gender on neurocognitive performance at baseline while controlling for a number of potential confounders including symptom burden at the time of testing. Differences in 3 of 5 composite scores as well as severity rating scores were maintained in multivariate analysis. Females had increased Post-Concussion Symptom Scale (β = 3.54, 95% confidence interval, 2.91 to 4.16, P < .0001) along with higher verbal memory (β = 1.82, 95% confidence interval, 1.15 to 2.50, P < .0001) and visual motor (β = 1.29, 95% confidence interval, 0.85-1.72, P < .0001) scores. Statistically significant gender differences were found in baseline neurocognitive function. This study clarifies for the first time that gender differences in these neurocognitive domains are not simply an artifact of differences in symptom burden. However, the small effect sizes call into question the clinical relevance of these differences.

Patient-reported symptom burden in routine oncology care: Examining racial and ethnic disparities.

BackgroundRacial and ethnic disparities are well‐documented in cancer outcomes such as disease progression and survival, but less is known regarding potential disparities in symptom burden.AimsThe goal of this retrospective study was to examine differences in symptom burden by race and ethnicity in a large sample of cancer patients. We hypothesized that racial and ethnic minority patients would report greater symptom burden than non‐Hispanic and White patients.Methods and resultsA total of 5798 cancer patients completed the Edmonton Symptom Assessment Scale—revised (ESAS‐r‐CSS) at least once as part of clinical care. Two indicators of symptom burden were evaluated: (1) total ESAS‐r‐CSS score (i.e., overall symptom burden) and (2) number of severe symptoms (i.e., severe symptomatology). For patients completing the ESAS‐r‐CSS on multiple occasions, the highest score for each indicator was used. Zero‐inflated negative binomial regression analyses were conducted, adjusting for other sociodemographic and clinical characteristics. Symptomology varied across race. Patients who self‐identified as Black reported higher symptom burden (p = .016) and were more likely to report severe symptoms (p < .001) than self‐identified White patients. Patients with “other” race were also more likely to report severe symptoms than White patients (p = .032), but reported similar total symptom burden (p = .315). Asian and Hispanic patients did not differ from White or non‐Hispanic patients on symptom burden (ps > .05).ConclusionThis study describes racial disparities in patient‐reported symptom burden during routine oncology care, primarily observed in Black patients. Clinic‐based electronic symptom monitoring may be useful to detect high symptom burden, particularly in patients who self‐identify their race as Black or other. Future research is needed to reduce symptom burden in racially diverse cancer populations.

Characterization of Clinical Symptoms by Race Among Women With Early-Stage, Hormone Receptor–Positive Breast Cancer Before Starting Chemotherapy

Race disparities persist in breast cancer mortality rates. One factor associated with these disparities may be differences in symptom burden, which may reduce chemotherapy tolerance and increase early treatment discontinuation. To compare symptom burden by race among women with early-stage breast cancer before starting chemotherapy and quantify symptom differences explained by baseline characteristics. A cross-sectional analysis of symptom burden differences by race among Black and White women with a diagnosis of stage I to III, hormone receptor-positive breast cancer who had a symptom report collected before chemotherapy initiation in a large cancer center in the southern region of the US from January 1, 2007, through December 31, 2015. Analyses were conducted from November 1, 2019, to March 31, 2021. Blinder-Oaxaca decomposition was used, adjusting for baseline sociodemographic and clinical characteristics. Four symptom composite scores with a mean (SD) of 50 (10) were reported before starting chemotherapy (baseline) and were derived from symptom items: general physical symptoms (11 items), treatment adverse effects (8 items), acute distress (4 items), and despair (7 items). Patients rated the severity of each symptom they experienced in the past week on a scale of 0 to 10 (where 0 indicates not a problem and 10 indicates as bad as possible). A total of 1338 women (mean [SD] age, 54.6 [11.6] years; 420 Black women [31.4%] and 918 White women [68.6%]) were included in the study. Before starting chemotherapy, Black women reported a statistically significantly higher (ie, worse) symptom composite score than White women for adverse effects (44.5 vs 43.8) but a lower acute distress score (48.5 vs 51.0). Decomposition analyses showed that Black patients' characteristics were associated with higher symptom burden across all 4 scores. However, these differences were offset by relatively greater, statistically significant, unexplained physical, distress, and despair symptom reporting by White patients. In this study, before starting chemotherapy, Black patients with early-stage breast cancer reported significantly higher burden for symptoms that may be exacerbated with chemotherapy and lower distress symptoms compared with White patients. Future studies should explore how symptoms change before and after treatment and differ by racial/ethnic groups and how they are associated with treatment adherence and mortality disparities.

Differences by race in patient-reported symptoms during chemotherapy among women with early-stage, hormone receptor-positive breast cancer.

6528 Background: Symptom burden may contribute to racial differences in cancer treatment adherence and survival. Evidence on changes in symptom burden during chemotherapy and whether these differ by race is scarce. We used patient reported outcomes data collected before and after breast cancer chemotherapy initiation to compare symptom burden by race. Methods: Using electronic medical records of a large cancer center in the southern region of the US, we identified Black and White women diagnosed with stage I-III, hormone-receptor positive breast cancer from January 2007 to December 2015. A tablet-based platform [ConcertAI] was used to collect patient reported symptoms at the point of care. We included patients with at least one completed symptom report before and during chemotherapy. We focused on two standardized composite scores – physical symptoms and treatment side-effect (mean of 50 and standard deviation of 10), and calculated changes in symptoms using the closest report before chemotherapy and the most severe score reported during chemotherapy. Patients with a 10-point increase were classified as having a clinically meaningful increase in symptom burden. We used Oaxaca-Blinder decomposition to quantify racial differences in symptom burden change explained by baseline characteristics. These included baseline symptom scores, sociodemographic characteristics (age, regional level household income and education, state) and clinical characteristics (cancer stage and primary chemo regimen). Results: Among 1,167 included patients, Black women (30%) were younger (52 vs. 55 years old, p&lt;.001), more likely to live in areas with lower median household income and less education, and reported most severe scores about 2 weeks later than White women ( p&lt;.05). They were also more likely to report a 10-point increase in symptom burden for physical (68.5% vs. 61.2%, p=.017) and side-effects symptoms score (49.0% vs. 41.4%, p=.015). This was driven by larger increases in selected individual symptoms among Black women, such as sweating, itching, and numbness (under physical symptom score), and hair loss and taste change (under side-effect score). Decomposition analyses showed that baseline characteristics (especially primary chemo regimen) explained 79.2% ( p=.002) and 35.2% ( p=.131) of the increased probability of Black women reporting a 10-point increase in physical symptom and side-effects scores respectively. Conclusions: Black women with early-stage breast cancer were more likely to report a clinically meaningful increase in treatment side-effects and physical symptoms during chemotherapy compared to White women. Differences by race in physical symptoms scores were mostly explained by baseline characteristics. Future studies should examine whether racial differences in symptom burden translate into differences in treatment adherence and mortality.

Does cranberry extract reduce antibiotic use for symptoms of acute uncomplicated urinary tract infections (CUTI)? A feasibility randomised trial

ObjectivesTo determine the feasibility of conducting a randomised trial of the effectiveness of cranberry extract in reducing antibiotic use by women with symptoms of acute, uncomplicated urinary tract infection (UTI).DesignOpen-label...