Routine Edmonton Symptom Assessment System (ESAS) scores in epithelioid malignant pleural mesothelioma (eMPM) patients undergoing palliative systemic therapy.

Abstract

96 Background: Palliative chemotherapy, the mainstay for incurable eMPM, is offered to patients with good standing performance status (ECOG 0-1). We determined the proportion of eMPM patients experiencing moderate (Mod) to severe (Sev) symptoms while on palliative chemotherapy using ESAS symptom scores at diagnosis and during first and subsequent lines of systemic therapy. Methods: ESAS scores (0=no symptom; 10=worst symptom) were routinely captured in eMPM patients at Princess Margaret (Toronto, Canada). Retrospective chart review collected ESAS, clinical, treatment and outcome data. ESAS scores and proportions were summarized within baseline, firstline, and subsequent lines of therapy. Mod symptom was defined as ESAS scores of 4-6, and Sev as 7-10. ESAS scores between treatment lines were analyzed by Mann-Whitney U tests. Locally weighted smoothing (LOESS) plots assessed ESAS scores over treatment duration. Results: Of 37 palliative eMPM patients, the most frequent baseline symptoms were fatigue (33% Mod, 25% Sev), dyspnea (27% Mod; 17% Sev), anxiety (21% Mod; 21% Sev) and depression (34% Mod; 4% Sev). Overall well-being was poor in 45% of patients (31% Mod; 14% Sev). Compared to baseline, patients on firstline therapy reported increased pain ( p = 0.002), poor appetite ( p = 0.005) and nausea ( p = 0.02); decreased depression ( p = 0.03) and anxiety ( p = 0.006); and stable well-being ( p = 0.27). In patients well enough for subsequent therapy, patients reported reduced drowsiness ( p = 0.01) and improved overall well-being ( p = 0.04) compared to firstline therapy. LOESS plot patterns were similar between firstline and subsequent lines of treatment. Conclusions: eMPM patients had high symptom scores at the time of diagnosis. However, patients’ depression and anxiety decreased when starting initial treatment, and general well-being was stable. Of patients fit enough for subsequent lines of therapy, there were improvements in drowsiness and overall well-being. When selectively used, palliative systemic therapy of all lines are associated with some improved symptoms, but pain, poor appetite, and nausea need to be monitored and managed more effectively.