Using the revised Edmonton symptom assessment scale during neoadjuvant radiotherapy for retroperitoneal sarcoma

Abstract

Background and purpose: Retroperitoneal sarcoma (RPS) is a rare, complex disease requiring multidisciplinary management. We have previously reported that use of the Revised Edmonton Symptom Assessment Scale (ESAS-r-CSS) allows for proactive symptom management, and we sought to report the results of ESAS-r-CSS screening during pre-operative radiotherapy (RT) for a cadre of patients with RPS. Materials and methods: We reviewed records of 47 patients with RPS evaluated at our institution between 2015 and 2018. Of this group, 29 non-metastatic patients were treated with definitive intent neoadjuvant RT with at least 2 weekly ESAS-r-CSS reports. A generalized estimating equation model was used to compare 13 symptoms during weekly on-treatment visits compared to baseline scores at week 1 of RT. Additionally, covariate effects of age, gender, dose, tumor size and location were assessed. Results: The population was predominantly male (66%) with median age of 65 years, KPS of 90, and tumor size of 12.8 cm. ESAS scores significantly decreased for anxiety at week 3 (P = 0.01), and pain at week 5 (P = 0.01). Worse constipation was reported at week 2 (P = 0.02). In an exploratory covariate analysis, female gender, age, high dose, and larger tumor size were associated with worse ESAS scores across all time points. Conclusion: Patient reporting of symptoms during radiotherapy through weekly ESAS-r-CSS facilitates timely management in patients with this unique tumor type. Expectant care during RT offers the opportunity to minimize symptom progression or treatment interruptions in a population that generally has worsening side effects.

Perioperative strategy and outcome in giant retroperitoneal dedifferentiated liposarcoma—results of a retrospective cohort study

“…However, the presented series are dealing with smaller tumor diameters. In this regard, there are recent studies of retroperitoneal liposarcoma with radiation therapy and a median tumor size between 12.8 cm [24], 14,5 cm [25], 13,6 cm [26], 15 cm [27], and 15,4 cm [28].…”

A critical narrative review of radiotherapy for retroperitoneal soft tissue sarcoma

“…Recently, Palm et al presented the use of the Revised Edmonton Symptom Assessment Scale (ESAS-r-CSS) reported by patients during radiotherapy. The observed correlation between symptoms or side effects with covariate effects of age, gender, dose, tumor size, and location may offer the opportunity to minimize radiation effect by preventing them or managing them earlier (95).…”

Systematic self-reporting of patients’ symptoms: improving oncologic care and patients’ satisfaction

“…[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Therefore, it is essential for patients to be able to effectively communicate any adverse effects they are experiencing to their healthcare providers. Several studies [4][5][6]8,10,12,[18][19][20][21][22][23][24][25][26][27][28][29][30] have reported that systematic self-reporting of patients' symptoms during their cancer journey has facilitated appropriate intervention, allowed patients to communicate their most relevant physical symptoms and psychosocial concerns to their healthcare providers and revealed the impact of cancer and treatment from patients' perspective. According to Basch et al 19 and Cleeland et al 20 , systematic symptom reporting by patients correlates with decreased symptom severity, reduced hospital and emergency room visits, and an improved reported wellbeing.…”

“…According to Goyal et al 32 , the incorporation of patient self-reported symptom scoring tools into treatment visits improved provider management of common cancers and radiotherapy-related symptoms and allowed for earlier referrals to supportive care clinics. Palm et al 27 also reviewed the Edmonton Symptom Assessment System (ESAS) symptom records of retroperitoneal sarcoma patients and concluded that the reporting of symptoms during radiotherapy using patient-reported outcomes for symptom management facilitates timely management of patients' symptoms. In a study by Schulman-Green et al 33 , they reported that using the ESAS has several benefits including being an easy tool capable of identifying areas of concern, engaging patients in symptom assessment, and monitoring symptom changes over time.…”