Symptom severity and complexity trends in patients undergoing radiation therapy

Abstract

Objective: Symptom severity has considerable impact on patients’ cancer care journey. This study aims to better understand psychological and physical symptom scores of radiotherapy patients across their radiotherapy care trajectory. Methods: Patients who received radiotherapy at a single tertiary cancer center, who also completed at least one symptom-reporting questionnaire, the Edmonton Symptom Assessment Scale – Revised (ESAS-r) between October 1, 2019 and April 1, 2020 were included in this retrospective analysis. Within the study period, time points included consultation, first and last radiation treatment reviews and first post-treatment follow-up. Symptoms were divided into psychological and physical. Mixed effect models assessed trajectories of psychological and physical scores across appointments. A symptom complexity score was assigned to each ESAS-r encounter. Symptom complexity score association with appointment type and tumor group was modelled using Generalized Estimating Equations (GEE). Results: The study cohort consisted of 1,632 patients who completed 2,519 ESAS-r questionnaires. Patients reported significantly higher psychological symptom scores at consultations than at first review, last review and follow-up. Patients reported significantly higher physical scores at last reviews compared to consultations. Patients at first review had significantly lower odds of having a higher (more severe) symptom complexity score, compared with patients at consultations (OR =0.77, 95% CI=0.64-0.93). Conclusions: Symptoms change over the course of a patient’s care trajectory. Understanding how particular symptoms change over time provides a target for initiatives that improve symptom management.