Severe Symptom Burden Research Articles

The Burden of symptoms and Quality of life of Filipino patients with Myeloproliferative neoplasm: A Multicenter Cross-sectional survey.

Myeloproliferative neoplasms (MPN) are hematologic malignancies characterized by cellular proliferation of one or more hematopoietic cell lines. Management has been focused on blood count control but addressing relief from symptoms and providing a better quality of life (QOL) are equally important in the care of these patients. The MPN Symptom Assessment Form-Total Symptom Score (MPN-SAF TSS) is used to determine symptoms at baseline and during treatment. Understanding the symptom burden is important in developing a holistic management plan for MPN. Hence, this study aimed to determine the symptom burden and QOL of Filipino patients with MPN. Using a validated Filipino version of the MPN-SAF-TSS questionnaire and the University of the Philippines-Department of Health QOL (UP-DOH QOL) questionnaire, a cross-sectional survey of consecutive patients with MPN from two public and two private tertiary hospitals was conducted. We purposively sampled adults, newly diagnosed or previously diagnosed with polycythemia vera (PV), essential thrombocythemia (ET), or myelofibrosis (MF). The mean scores were compared with the type of MPN using analysis of variance. Linear regression was done to determine the association of patients' characteristics to the mean symptom burden and QOL scores, while logistic regression was used to determine the association of patient and disease characteristics with the level of symptom severity and QOL. A total of 167 (63 PV, 66 ET, and 38 MF) patients were surveyed from four centers. The mean overall symptom burden score was 24.41 (standard deviation [SD]=18.91) with MF having the highest score at 28.53, followed by PV at 23.75 and ET at 22.67. The majority (80.24%) had a high QOL with a mean global QoL score of 84.92 (SD=16.75). Comparison of individual scores showed bone pain and weight loss were significantly higher in patients with MF compared to PV (p=0.0002) and ET (p=0.032); while pruritus was significantly higher in PV compared to ET and MF (p=0.043). Logistic regression analysis showed female sex and being newly diagnosed (adjusted odds ratio [aOR] 11.22, 95% confidence interval [CI] 2.32-54.25) were associated with high symptom burden while having a controlled blood count (aOR 0.26, 95% CI 0.10-0.71) was associated with low symptom burden and high QOL. The majority of the participants were symptomatic with moderate to severe symptom burden. While no statistically significant difference was seen among the three types of MPN in terms of overall mean symptom score, patients with MF were more likely to have a severe symptom burden while patients with ET had the least symptoms. Despite having symptoms, QOL was regarded as high. QoL was significantly higher among those with PV or ET than those with MF. Our study highlighted the utility of a validated symptom scoring system in determining the symptom burden and who would benefit from pharmacologic/non-pharmacologic symptom management. Results emphasized incorporating symptom scoring in clinical practice and going beyond blood counts in caring for our patients with MPN.

Contemporaneous Symptom Networks of Breast Cancer-Related Upper Limb Lymphedema: A Network Analysis.

Upper limb lymphedema (ULL) is a common and deliberating complication for breast cancer survivors (BCSs). Breast cancer survivors with ULL reported a wide range of symptoms. However, little is known about symptom patterns and interrelationships among them. This study was designed to explore symptom clusters and construct symptom networks of ULL-related symptoms among BCSs and to identify the core symptoms. This study is a secondary data analysis using datasets from three cross-sectional studies of BCSs in China. A total of 341 participants with maximum interlimb circumference ≥2 cm and complete responses in Part I of the Breast Cancer and Lymphedema Symptom Experience Index were included. Symptom clusters were identified through principal component analysis, and multiple linear regression analysis was employed to explore factors associated with severity of overall ULL-related symptoms. A contemporaneous network with 20 frequently reported symptoms were constructed after controlling for covariates. Three symptom clusters, including lymph stasis symptom cluster, nerve symptom cluster, and movement limitation symptom cluster, were identified. Postsurgery time, axillary lymph node dissection, and radiotherapy were associated with the severity of ULL-related symptoms. Tightness (rs = 1.379; rscov = 1.097), tingling (rs = 1.264; rscov = 0.925), and firmness (rs = 1.170; rscov = 0.923) were the most central symptoms in both networks with and without covariates. Breast cancer survivors with ULL experienced severe symptom burden. Tightness, tingling, and firmness were core symptoms of ULL among BCSs. Our findings demonstrated that the assessment and targeted intervention of specific core symptoms might help to relive effectively the burden of ULL-related symptom among BCSs.

Characterizing the Physical and Psychological Experiences of Newly Diagnosed Pancreatic Cancer Patients.

Pancreatic cancer is a devastating disease with a poor prognosis, causing significant physical and psychological distress that detrimentally impacts patients' quality of life. This study aimed to comprehensively assess the physical and psychological status of newly diagnosed pancreatic cancer patients. A cohort of 138 newly diagnosed patients completed standardized assessments, including the Edmonton Symptom Assessment System (ESAS), Patient Health Questionnaire-9 (PHQ-9), Mini-Mental State Examination (MMSE), and Distress Thermometer (DT). Data were analysed using descriptive statistics. The ESAS scores revealed high symptom burden, with mean scores of 6.8 for pain, 7.2 for fatigue, and 4.9 for depression. Measures of well-being indicated low scores, with means of 2.3 for physical well-being, 1.5 for social/family well-being, and 1.7 for emotional well-being. Distress levels were also high, with a mean score of 7.6 on the DT. Newly diagnosed pancreatic cancer patients experience substantial physical and psychological challenges, including severe symptom burden, distress, depressive symptoms, and cognitive impairment. Holistic care approaches that prioritize symptom management and address psychological distress are essential to improve patient outcomes and enhance overall well-being.

Somatic symptom disorder symptoms in individuals at risk for heart failure: A cluster analysis with cross-sectional data from a population-based cohort study

ObjectiveIdentifying whether experienced symptom burden in individuals with medical predisposition indicates somatic symptom disorder (SSD) is challenging, given the high overlap in the phenomenology of symptoms within this group. This study aimed to enhance understanding SSD in individuals at risk for heart failure. Subjects and methodsCross-sectional data from the Hamburg City Health Study was analyzed including randomly selected individuals from the general population of Hamburg, Germany recruited from February 2016 to November 2018. SSD symptoms assessed with the Somatic Symptom Scale-8 and the Somatic Symptom Disorder-12 scale were categorized by applying cluster analysis including 412 individuals having at least 5% risk for heart failure-related hospitalization within the next ten years. Clusters were compared for biomedical and psychological factors using ANOVA and chi-square tests. Linear regressions, adjusting for sociodemographic, biomedical, and psychological factors, explored associations between clusters with general practitioner visits and quality of life. ResultsThree clusters emerged: none (n = 215; 43% female), moderate (n = 151; 48% female), and severe (n = 46; 54% female) SSD symptom burden. The SSS-8 mean sum scores were 3.4 (SD = 2.7) for no, 6.4 (SD = 3.4) for moderate, and 12.4 (SD = 3.7) for severe SSD symptom burden. The SSD-12 mean sum scores were 3.1 (SD = 2.6) for no, 12.2 (SD = 4.2) for moderate, and 23.5 (SD = 6.7) for severe SSD symptom burden. Higher SSD symptom burden correlated with biomedical factors (having diabetes: p = .005 and dyspnea: p ≤ .001) and increased psychological burden (depression severity: p ≤ .001; anxiety severity: p ≤ .001), irrespective of heart failure risk (p = .202). Increased SSD symptoms were associated with more general practitioner visits (β = 0.172; p = .002) and decreased physical quality of life (β = −0.417; p ≤ .001). ConclusionBiomedical factors appear relevant in characterizing individuals at risk for heart failure, while psychological factors affect SSD symptom experience. Understanding SSD symptom diversity and addressing subgroup needs could prove beneficial.

Liver Transplantation for Benign Massive Hepatomegaly: Results From a Single Center and Contribution of the Left-to-Right Piggyback Approach

IntroductionPolycystic liver disease and giant hepatic hemangioma may present with severe symptom burden and indicate orthotopic liver transplantation. The left-to-right piggyback approach is a useful technique for performing total hepatectomy of enlarged livers. ObjectiveThe purpose of this study is to analyze the results of liver transplantation in patients with benign massive hepatomegaly. MethodsThis is a single-center retrospective study involving all adult patients who underwent liver transplantation due to benign massive hepatomegaly from January 2002 to June 2023. ResultsA total of 22 patients underwent liver transplantation (21 cases of polycystic live disease and 1 case of giant hepatic hemangioma). During the same time, there were 2075 transplants; therefore, benign massive hepatomegaly accounted for 1.06% of cases. Most patients (59.09%) were transplanted using the left-to-right piggyback technique. Seven patients had previous attempted treatment of hepatic cysts. Another patient previously underwent bilateral nephrectomy and living-donor kidney transplantation. Among these patients, in 5 cases there were massive abdominal adhesions with increased bleeding. Four of these 8 patients died in the very early perioperative period. In comparison to patients without previous cysts manipulation, massive adhesions and perioperative death were significantly higher in those cases (62.5 vs 0%, P = .002 and 50% vs 0%, P = .004, respectively). ConclusionLiver transplantation due to polycystic liver disease and giant hemangioma is a rare event. Total hepatectomy is challenging due to the enlarged native liver. The left-to-right piggyback technique is useful, because it avoids vena cava twisting and avulsion of its branches. Massive adhesions due to previous cysts manipulation may lead to increased bleeding, being a risk factor for mortality.

A systematic review and meta-analysis of the impacts of germline pharmacogenomics on severe toxicity and symptom burden in adult patients with cancer.

The clinical application of Pharmacogenomics (PGx) has improved patient safety. However, comprehensive PGx testing has not been widely adopted in clinical practice, and significant opportunities exist to further optimize PGx in cancer care. This systematic review and meta-analysis aim to evaluate the safety outcomes of reported PGx-guided strategies (Analysis 1) and identify well-studied emerging pharmacogenomic variants that predict severe toxicity and symptom burden (Analysis 2) in patients with cancer. We searched MEDLINE, EMBASE, CENTRAL, clinicaltrials.gov, and International Clinical Trials Registry Platform from inception to January 2023 for clinical trials or comparative studies evaluating PGx strategies or unconfirmed pharmacogenomic variants. The primary outcomes were severe adverse events (SAE; ≥ grade 3) or symptom burden with pain and vomiting as defined by trial protocols and assessed by trial investigators. We calculated pooled overall relative risk (RR) and 95% confidence interval (95%CI) using random effects models. PROSPERO, registration number CRD42023421277. Of 6811 records screened, six studies were included for Analysis 1, 55 studies for Analysis 2. Meta-analysis 1 (five trials, 1892 participants) showed a lower absolute incidence of SAEs with PGx-guided strategies compared to usual therapy, 16.1% versus 34.0% (RR = 0.72, 95%CI 0.57-0.91, p = 0.006, I2 = 34%). Meta-analyses 2 identified nine medicine(class)-variant pairs of interest across the TYMS, ABCB1, UGT1A1, HLA-DRB1, and OPRM1 genes. Application of PGx significantly reduced rates of SAEs in patients with cancer. Emergent medicine-variant pairs herald further research into the expansion and optimization of PGx to improve systemic anti-cancer and supportive care medicine safety and efficacy.

Abstract 7440: Symptom network analysis and unsupervised clustering of a cohort of oncology patients identifies drivers of symptom burden and patient subgroups with distinct symptom patterns

Abstract Purpose: Inter-individual variability in oncology patients’ symptom experiences poses significant challenges in prioritizing symptoms for targeted intervention(s). In this study, computational approaches were used to unbiasedly characterize the heterogeneity of the symptom experience of oncology patients to elucidate their symptom patterns and drivers of symptom burden. Methods: Severity ratings for 32 symptoms on the Memorial Symptom Assessment Scale from 3088 oncology patients were analyzed. Gaussian Graphical Model symptom networks were constructed for the entire cohort and subgroups identified through unsupervised clustering of symptom co-severity patterns. Symptom network characteristics were analyzed and compared using permutation-based statistical tests. Demographic and clinical characteristic differences between subgroups were assessed using multinomial logistic regression. Results: Network analysis of the entire cohort revealed three core symptom clusters: constitutional, gastrointestinal-epithelial, and psychological. Lack of energy was identified as central to the network, suggesting that it plays a crucial role in driving overall symptom burden and may be the most salient to target clinically. Unsupervised clustering of patients based on shared symptom co-severity patterns identified six patient subgroups with distinct symptom patterns and demographic and clinical characteristics. The first subgroup represented a baseline cohort of patients who are most affected by common constitutional symptoms of cancer care. The second subgroup represented patients with severe overall symptom burden. The third subgroup represented patients primarily experiencing neuropathy. The fourth subgroup represented patients with advanced disease and treatment-related symptoms but relatively high quality of life. The fifth subgroup represented younger patients with pronounced psychological disease burden. The sixth subgroup represented patients with minimal symptom burden. Age, treatment status, and Karnofsky Performance Score were the strongest determinants of subgroup membership, but their interplay (in one case even with ethnicity) reaffirms the complex multi-factorial nature of the symptom experience. For each subgroup, symptoms with the highest network centralities that should be prioritized for management were identified. Conclusions: This study provides a translational research framework for clinicians to better understand and address the symptom care needs of oncology patients. The framework combines unbiased stratification of patients and in-depth modeling of symptom relationships to capture the heterogeneity in their experiences. When validated, the identified core symptoms and associated clinical determinants may inform precision-based symptom management. Citation Format: Brandon H. Bergsneider, Terri S. Armstrong, Yvette P. Conley, Bruce Cooper, Marilyn Hammer, Jon D. Levine, Steven Paul, Christine Miaskowski, Orieta Celiku. Symptom network analysis and unsupervised clustering of a cohort of oncology patients identifies drivers of symptom burden and patient subgroups with distinct symptom patterns [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 7440.

Comparing Preferences for Disease Profiles: A Discrete Choice Experiment from a US Societal Perspective.

There is increasing interest in expanding the elements of value to be considered when making health policy decisions. To help inform value frameworks, this study quantified preferences for disease attributes in a general public sample and examined which combination of attributes (disease profiles) are considered most important for research and treatment. A discrete choice experiment (DCE) was conducted in a US general population sample, recruited through online consumer panels. Respondents were asked to select one of a set of health conditions they believed to be most important, characterized by attributes defined by a previous qualitative study: onset age; cause of disease; life expectancy; caregiver requirement; symptom burden (characterized by the Health Utilities Index with varying levels of ambulation independence, dexterity limitations, and degree of pain and discomfort); and disease prevalence. A fractional factorial DCE design was implemented using R, and 60 choice sets were generated (separated into blocks of 10 per participant). Data were analyzed using a mixed-logit regression model, and results used to assess the likelihood of preferring disease profiles. Based on individual attribute preferences, overall preferences for disease profiles, including a profile aligned with Duchenne muscular dystrophy (DMD), were compared. Fifty-two percent of respondents (n = 537) were female, and 70.6% were aged 18-54 years. Attributes considered most important were those related to life expectancy (odds ratio [OR], 95% confidence interval [CI] 1.88 [1.56-2.27] for a 50% reduction in remaining life expectancy vs no impact), and symptom burden (OR [95% CI] 1.84 [1.47-2.31] for severe vs mild burden). Greater importance was also found for pediatric onset, caregiver requirement, and diseases affecting more people. As an example of disease profile preferences, a DMD-like pediatric inherited disease with 50% reduction in life expectancy, extensive caregiver requirement, severe symptom burden, and 1:5000 prevalence had 2.37-fold higher odds of being selected as important versus an equivalent disease with adult onset and no life expectancy reduction. Of disease attributes included in this DCE, respondents valued higher prevalence of disease, life expectancy and symptom burden as most important for prioritizing research and treatment. Based on expressed attribute preferences, a case study of an inherited pediatric disease involving substantial reductions to length and quality of life and requiring caregiver support has relatively high odds of being identified as important compared to diseases reflecting differing attribute profiles. These findings can help inform expansions of value frameworks by identifying important attributes from the societal perspective.

COVID-19 illness severity and 2-year prevalence of physical symptoms: an observational study in Iceland, Sweden, Norway and Denmark.

Although the persistence of physical symptoms after SARS-CoV-2 infection is a major public health concern, evidence from large observational studies beyond one year post diagnosis remain scarce. We aimed to assess the prevalence of physical symptoms in relation to acute illness severity up to more than 2-years after diagnosis of COVID-19. This multinational study included 64,880 adult participants from Iceland, Sweden, Denmark, and Norway with self-reported data on COVID-19 and physical symptoms from April 2020 to August 2022. We compared the prevalence of 15 physical symptoms, measured by the Patient Health Questionnaire (PHQ-15), among individuals with or without a confirmed COVID-19 diagnosis, by acute illness severity, and by time since diagnosis. We additionally assessed the change in symptoms in a subset of Swedish adults with repeated measures, before and after COVID-19 diagnosis. During up to 27 months of follow-up, 34.5% participants (22,382/64,880) were diagnosed with COVID-19. Individuals who were diagnosed with COVID-19, compared to those not diagnosed, had an overall 37% higher prevalence of severe physical symptom burden (PHQ-15 score ≥15, adjusted prevalence ratio [PR] 1.37 [95% confidence interval [CI] 1.23-1.52]). The prevalence was associated with acute COVID-19 severity: individuals bedridden for seven days or longer presented with the highest prevalence (PR 2.25 [1.85-2.74]), while individuals never bedridden presented with similar prevalence as individuals not diagnosed with COVID-19 (PR 0.92 [0.68-1.24]). The prevalence was statistically significantly elevated among individuals diagnosed with COVID-19 for eight of the fifteen measured symptoms: shortness of breath, chest pain, dizziness, heart racing, headaches, low energy/fatigue, trouble sleeping, and back pain. The analysis of repeated measurements rendered similar results as the main analysis. These data suggest an elevated prevalence of some, but not all, physical symptoms during up to more than 2 years after diagnosis of COVID-19, particularly among individuals suffering a severe acute illness, highlighting the importance of continued monitoring and alleviation of these targeted core symptoms. This work was mainly supported by grants from NordForsk (COVIDMENT, grant number 105668 and 138929) and Horizon 2020 (CoMorMent, 847776). See Acknowledgements for further details on funding.

The importance of screening for functional neurological disorders in patients with persistent post-concussion symptoms.

Functional neurological disorder (FND) may commonly co-occur with persistent symptoms following a psychological trauma or physical injury such as concussion. To explore the occurrence of FND in a population with persistent post-concussion symptoms (PPCS) and the associations between FND and depression as well as anxiety in participants with PPCS. Sixty-three individuals with PPCS presenting to a specialized brain injury clinic completed the following questionnaires: screening for somatoform disorder conversion disorder subscale (SOM-CD), Rivermead post-concussion symptom questionnaire (RPQ), patient health questionnaire-9 (PHQ-9), and generalized anxiety disorder questionnaire- 7 (GAD-7). Both multiple linear regression and logistic regression were conducted to evaluate the relationship between questionnaires and adjust for covariates. We found that total RPQ score (βˆ= 0.27; 95% CI = [0.16, 0.38]), GAD-7 score (βˆ= 0.71; 95% CI = [0.50, 0.92]) and PHQ-9 score (βˆ= 0.54; 95% CI = [0.32, 0.76]) were positively associated with SOM-CD score individually, after consideration of other covariates. Participants meeting the criteria for severe FND symptoms were 4.87 times more likely to have high PPCS symptom burden (95% CI = [1.57, 22.84]), 8.95 times more likely to have severe anxiety (95% CI = [3.31, 35.03]) and 4.11 times more likely to have severe depression symptom burden (95% CI = [1.77, 11.53]). The findings of this study indicate an association between FND and post-concussion symptoms as well as an association between FND and symptoms of depression and anxiety in patients with PPCS. Patients with PPCS should be screened for FND to provide a more targeted treatment approach that includes somatic-focused interventions.

Symptom profiles and related factors among patients with advanced cancer: A latent profile analysis

ObjectiveThis study aimed to investigate symptom subgroups and associated influencing factors in patients with advanced cancer. MethodsA cross-sectional study was conducted, involving 416 patients with advanced cancer. The study examined five symptoms: fatigue, pain, sleep impairment, anxiety, and depression. Latent Profile Analysis (LPA) was utilized to classify symptom subgroups. A multiple logistic regression analysis was conducted to explore factors associated with the identified symptom subgroups. ResultsThe analysis revealed three distinct subgroups among the participants: “all low” (58.2%), characterized by normal symptoms except for moderate sleep quality; “all moderate” (35.1%), exhibiting normal symptoms except for poor sleep quality and fatigue; and “all high” (6.7%), experiencing normal pain, moderate depression, moderate anxiety, poor sleep quality, and fatigue. Malnutrition risk, cancer diagnosis, and cancer survivorship duration were found to be associated with a more severe symptom burden. ConclusionsPatients in the “all high” subgroup faced an increased risk of malnutrition and a longer cancer survivorship duration. Additionally, patients in the “all moderate” subgroup were distinguished by having a breast cancer diagnosis. These findings have significant implications for allocating medical resources and implementing person-centered symptom management strategies.

Psychological symptom burden associated with malignant wounds: Secondary analysis of a prospective cohort study.

Patients with malignant wounds suffer from physical and psychological symptom burden. Despite psychological support being required, the impact of malignant wounds on patients' psychological distress is poorly investigated. We evaluated psychological distress associated with malignant wounds for patients at their end of life. This study used the secondary analysis of the results of a large prospective cohort study, which investigated the dying process among patients with advanced cancer in 23 palliative care units in Japan. The primary outcome of this study was the prevalence of moderate to severe psychological symptom burden, evaluated by the Integrated Palliative Care Outcome Scale (IPOS)-feeling at peace scores of 2-4. In addition, the factors affecting psychological symptoms were investigated. The quality of death was also evaluated upon death using the Good Death Scale score. Out of the total 1896 patients, 156 had malignant wounds (8.2%). Malignant wounds were more common in female and young people. The breast, head, and neck were the most prevalent primary sites. More patients with malignant wounds had IPOS-feeling at peace scores of 2-4 than patients without malignant wounds (41.0% vs. 31.3%, p=0.024). Furthermore, psychological distress was associated with moderate to severe IPOS-pain and the frequency of dressing changes. The presence of malignant wounds did not affect the quality of death. This study showed increased psychological distress due to malignant wounds. Patients with malignant wounds require psychological support in addition to the treatment of physical symptoms for maintaining their quality of life.

Pulmonary rehabilitation assessment in COPD based on the ICF brief core set: a latent profile analysis

Background Chronic obstructive pulmonary disease (COPD) is the most burdened chronic respiratory disease in the world, resulting in a reduced quality of life and limited physical activity for patients. Pulmonary rehabilitation (PR) is an effective therapy for COPD. Effective PR relies on an accurate pulmonary rehabilitation program. An adequate pre-rehabilitation assessment helps healthcare professionals to develop an accurate pulmonary rehabilitation program. However, pre-rehabilitation assessment strategies lack specific selection criteria and an assessment of the patient’s overall functioning. Methods This study explored the functional characteristics of COPD patients before pulmonary rehabilitation and collected COPD patients from October 2019 to March 2022. A cross-sectional survey of 237 patients was conducted using the ICF brief core set as the study tool. Latent profile analysis identified subgroups of patients with different rehabilitation needs based on body function and activity participation. Results Four subgroups of functional dysfunction were identified: 5.42%, 21.03%, 29.44%, and 34.11% in the high dysfunction group, the moderate dysfunction group, the lower-middle dysfunction but high mobility impairment group, and the low dysfunction group, respectively. Patients in the high dysfunction group were older, had a higher proportion of widowed spouses, and experienced more exacerbation. Most patients in the low-dysfunction group did not use inhaled medication and had a lower participation rate in oxygen therapy. Patients with a more severe disease classification and symptom burden mostly belonged to the high dysfunction group. Conclusions COPD patients require an adequate assessment before implementing a pulmonary rehabilitation program to determine their rehabilitation needs. The four subgroups were heterogeneous in terms of the degree of functional impairment in body function and activity participation. Patients in the high dysfunction group can improve basic cardiorespiratory fitness; patients in the moderate dysfunction group should focus on improving cardiorespiratory endurance and muscle fitness, patients in the lower-middle-dysfunction but high mobility impairment group should focus on improving mobility and patients in the low functional disability group should focus more on preventive measures. Healthcare providers can tailor rehabilitation programs to the functional impairments of patients with different characteristics. Trial registration This study has been registered in the Chinese Clinical Trials Registry (ChiCTR2000040723).

Utility of Patient-Reported Symptom and Functional Outcomes to Indicate Recovery after First 90 Days of Radical Cystectomy: A Longitudinal Study.

This is a longitudinal prospective study that tracked multiple symptom burden and functioning status for bladder cancer (BLC) patients for 3 months post-radical cystectomy at The University of Texas MD Anderson Cancer Center, using a validated disease-specific patient-reported outcome measure (PROM) tool, the MD Anderson Symptom Inventory (the MDASI-PeriOp-BLC). The feasibility of collecting an objective measure for physical functioning, using "Timed Up & Go test" (TUGT) and PRO scores at baseline, discharge and end of study, was tested. Patients (n = 52) received care under an ERAS pathway. The more severe scores of fatigue, sleep disturbance, distress, drowsiness, frequent urination and urinary urgency at baseline predicted poor functional recovery postoperatively (OR = 1.661, 1.039-2.655, p = 0.034); other more severe symptoms at discharge (pain, fatigue, sleep disturbance, lack of appetite, drowsiness, bloating/abdominal tightness) predicted poor functional recovery (OR = 1.697, 1.114-2.584, p = 0.014) postoperatively. Compliance rates at preoperative, discharge and end of study were 100%, 79% and 77%, while TUGT completion rates were 88%, 54% and 13%, respectively. This prospective study found that more severe symptom burden at baseline and discharge is associated with poor functional recovery post-radical cystectomy for BLC. The collection of PROs is more feasible than using performance measures (TUGT) of function following radical cystectomy.

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.

Baseline symptom, health status, and health utilities in patients in early-phase clinical trials combining immune checkpoint blockade with other anticancer therapies.

12117 Background: The overall goal of our prospective and longitudinal study (NCI R01CA242565) is to examine the use of patient report to evaluate symptomatic adverse events associated with combination treatment including at least one immune checkpoint inhibitor in early-stage clinical trials. We present here the baseline symptom, health status and utilities in patients prior to trial start, and their association with clinical factors. Methods: Patients scheduled to start an early-phase trial of combination treatment with at least one immune checkpoint inhibitor and who had not received clinical trial-related treatment completed the validated MD Anderson Symptom Inventory - Immunotherapy (0-10, higher scores = worse severity) and the validated EuroQoL-5 dimensions questionnaire including a visual analog scale (EQ5D VAS) (0-100, higher scores = better health status) and health utility items (e.g., self-care, mobility). Clinical data were extracted from the EMR. Statistical tests included Spearman’s correlation coefficients. Results: At baseline prior to start of trial-related treatment, 38% of patients (N = 164; median age = 60 y; 52% male; 85% White; 17% ECOG PS 0, 89% ECOG PS 1, 3% ECOG PS 2) experienced at least 1 severe symptom (≥7 on 0-10 scale). The most frequent severe baseline symptoms were pain (21% of patients), fatigue (17%), disturbed sleep (15%), drowsiness (12%), lack of appetite (10%), distress (10%), and pain in the abdomen (10%). Less than 2% of pts experienced severe immunotherapy-specific symptoms of rash, fever/chills and swelling of the hands and feet at baseline. Moderate-severe symptom-related interference (≥4 on 0-10 scale) was worst for activity (40% of patients), work (38%), and enjoyment of life (30%). For the EQ5D health utility dimensions, patients reported the most problems with pain or discomfort (75%) and fewest problems with self-care (10%). Worse composite symptom severity (P = 0.013) and worse problems with activity (P = 0.001) and pain (P = 0.012) were associated with worse and higher ECOG PS. Worse symptom severity (-0.54, P &lt; 0.001), symptom interference with activity- (-0.57, P &lt; 0.001) and mood- (-0.42, P &lt; 0.001) related functioning were associated inversely with superior health status. Worse symptom interference with activity-related functioning was linked with lower concurrent lymphocyte counts (P = 0.01), hemoglobin (P = 0.01) and serum albumin (P = 0.004) levels and higher platelet (P = 0.02) counts. Conclusions: Patients in early-phase trials that combine immunotherapy with other anti-cancer therapies may experience severe symptom burden and symptom interference with functioning, even at baseline prior to treatment start. Thus, it is important to baseline symptoms to fully understand the impact of combination treatments including checkpoint inhibitors in early-stage clinical trials.

"The farm has an insatiable appetite": A food justice approach to understanding beginning farmer stress

Beginning farmers are critical in shaping resilient food systems amid a worsening climate crisis. Reports indicate a prevalence of stress and adverse mental health outcomes among U.S. farmers, yet there are gaps in the literature concerning the well-being of beginning farmers, a heterogeneous group with a growing number of women and BIPOC (Black, Indigenous, or People of Color) producers. The agricultural industry has a legacy of systemic oppression and exploitation of marginal commu­nities. Thus, it is important to understand the unique needs of an emerging, more diverse generation of farmers, especially as discrimination is associated with stress and poor mental health outcomes. In this community-engaged, mixed methods research project, we utilize a food justice framework to understand systemic stressors and coping strategies among Midwestern beginning farmers. Beginning farmers in the Midwest were recruited using pur­posive sampling to participate in quantitative surveys and in-depth interviews. The survey (n=62) included measures of farm stress, mental health supports, and farm charac­teristics; the Patient Health Questionnaire-4; and socio­demographic information. Interviews (n=20) were conducted to establish a deeper under­standing of stress and mental health experiences. Survey data were analyzed using descriptive statistics. Inter­views were analyzed using thematic analysis. Top stressors included having too much to do and too little time, COVID-19, not enough person-power on the farm, climate change, and social justice. Of survey respondents, 58% reported mild to severe symptom burden of anxiety or depression. Five qualita­tive themes emerged, including the stress of capitalism, discrimination and inequitable access to resources, aids and gaps in social support, rugged individ­ualism, and heterogeneous perspectives on social justice and climate change. Four transfor­mative food justice practices aimed at rectifying structural inequalities inform our implications. Our results emphasize the urgency of systemic change and structural support for beginning farmers.

Exploration of symptom clusters during hemodialysis and symptom network analysis of older maintenance hemodialysis patients: a cross-sectional study

BackgroundSymptom networks can provide empirical evidence for the development of personalized and precise symptom management strategies. However, few studies have established networks of symptoms experienced by older patients on maintenance hemodialysis. Our goal was to examine the type of symptom clusters of older maintenance hemodialysis patients during dialysis and construct a symptom network to understand the symptom characteristics of this population.MethodsThe modified Dialysis Symptom Index was used for a cross-sectional survey. Network analysis was used to analyze the symptom network and node characteristics, and factor analysis was used to examine symptom clusters.ResultsA total of 167 participants were included in this study. The participants included 111 men and 56 women with a mean age of 70.05 ± 7.40. The symptom burdens with the highest scores were dry skin, dry mouth, itching, and trouble staying asleep. Five symptom clusters were obtained from exploratory factor analysis, of which the clusters with the most severe symptom burdens were the gastrointestinal discomfort symptom cluster, sleep disorder symptom cluster, skin discomfort symptom cluster, and mood symptom cluster. Based on centrality markers, it could be seen that feeling nervous and trouble staying asleep had the highest strength, and feeling nervous and feeling irritable had the highest closeness and betweenness.ConclusionsHemodialysis patients have a severe symptom burden and multiple symptom clusters. Dry skin, itching, and dry mouth are sentinel symptoms in the network model; feeling nervous and trouble staying asleep are core symptoms of patients; feeling nervous and feeling irritable are bridge symptoms in this symptom network model. Clinical staff can formulate precise and efficient symptom management protocols for patients by using the synergistic effects of symptoms in the symptom clusters based on sentinel symptoms, core symptoms, and bridge symptoms.

Symptoms in the acute phase of SARS-CoV-2 infection among Danish children aged 0–14 years

To investigate the prevalence and burden of proxy-reported acute symptoms in children in the first 4 weeks after detection of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, and factors associated with symptom burden. Nationwide cross-sectional survey using parental proxy reporting of symptoms associated with SARS-CoV-2 infection. In July 2021, a survey was sent to the mothers of all Danish children aged 0-14 years with a positive SARS-CoV-2 polymerase chain reaction (PCR) test between January 2020 and July 2021. The survey included 17 symptoms associated with acute SARS-CoV-2 infection and questions about comorbidities. Of 38,152 children with a positive SARS-CoV-2 PCR test, 10,994 (28.8%) mothers responded. The median age was 10.2 (range 0.2-16.0) years and 51.8% were male. Among participants, 54.2% (n=5957) reported no symptoms, 43.7% (n=4807) reported mild symptoms, and 2.1% (n=230) reported severe symptoms. The most common symptoms were fever (25.0%), headache (22.5%) and sore throat (18.4%). Asthma {odds ratio (OR) 1.91 [95% confidence interval (CI) 1.57-2.32) and OR 2.11 (95% CI 1.36-3.28)}, allergy [OR 1.31 (95% CI 1.14-1.52) and OR 1.70 (95% CI 1.18-2.46], eczema [OR 1.43 (95% CI 1.20-1.71) and OR 2.03 (95% CI 1.38-2.97)] and OCD/anxiety/depression [OR 2.06 (95% CI 1.39-3.06) and OR 3.79 (95% CI 1.80-7.97)] were associated with reporting a higher symptom burden [values indicate outcomes reporting three or more acute symptoms (upper quartile) and reporting a severe symptom burden, respectively]. The highest prevalence of symptoms was found among children aged 0-2 and 12-14 years. Among SARS-CoV-2-positive children aged 0-14 years, approximately half reported no acute symptoms within the first 4 weeks after a positive PCR test. Most symptomatic children reported mild symptoms. Several comorbidities were associated with reporting a higher symptom burden.

Symptom burden and functioning status in patients with advanced upper gastrointestinal cancers.

311 Background: Providing accurate symptom profiles is essential to facilitate integration of patient-reported outcome measures (PROs) into routine oncologic care. This study described the symptom trajectories and functioning status in patients with advanced esophageal, gastroesophageal junction (GEJ), or gastric cancers. Methods: The study included adult patients with advanced upper gastrointestinal (UGI) cancers who were initiating a new line of therapy at time of enrollment. Multiple symptoms were assessed weekly for 12 weeks, then every two weeks until Week 36 using the electronically administered M.D. Anderson Symptom Inventory GI module (MDASI-GI). Patients also completed the EORTC QLQ-C30 every six weeks. Longitudinal PRO data were analyzed using mixed-effect models. Time to deterioration was estimated using Kaplan-Meier method. Multivariable regression models evaluated the association of PROs with tumor response. Patients were classified in a high symptom burden group if their MDASI-GI symptoms were scored &gt; 4 (scale of 0-10) for trajectory analysis. Results: Of the 111 enrolled patients, primary tumor site was available for 108 patients: esophageal (33%), GEJ (26%), gastric (41%). The mean age was 60.2 years; 70% were male. Nineteen patients who dropped within one week after baseline reported more severe vomiting and inability to eat than those who provided more post-baseline data (n=92). For the 92 patients, the top 6 most severe items at baseline were fatigue, lack of appetite, disturbed sleep, pain, drowsiness, and inability to eat. At baseline, patients who were treatment-naïve (n=43) reported more severe symptom burden and financial difficulty than patients who had received prior therapy (n=49). Those who were treatment-naïve reported faster general activity deterioration during the first 12 weeks than those who had received prior treatment (hazard ratio=2.183, 95% CI: 1.018, 4.673). More severe shortness of breath at baseline was significantly associated with better tumor response by Week 12 (odds ratio=1.35, 95% CI: 1.05, 1.74) for all patients with tumor response data. Trajectory analysis showed high symptom burden for pain (35% of patients), fatigue (60%), disturbed sleep (32%), lack of appetite (60%), drowsiness (54%), difficulty swallowing (37%), and inability to eat (50%) during the initial 12 weeks. High symptom burden continued for pain (41% of patients), fatigue (55%), lack of appetite (59%), drowsiness (48%), and numbness (29%) for Weeks 12-36. Conclusions: This longitudinal study documented high prevalence of disease- and treatment-related symptom burden and functioning deterioration among patients with advanced UGI cancers. These data support the implementation of PRO assessment in the routine patient care of this cohort of patients with significant physical and psychosocial challenges.