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Supportive Care in Cancer
Published in: Supportive Care in Cancer 5/2016

Open Access 01-05-2016 | Original Article

Longitudinal patterns of cancer patient reported outcomes in end of life care predict survival

Authors: George J. Stukenborg, Leslie J. Blackhall, James H. Harrison, Patrick M. Dillon, Paul W. Read

Published in: Supportive Care in Cancer | Issue 5/2016

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Abstract

Purpose

Patients with advanced cancer typically demonstrate sharp deterioration in physical function and psychological status during the last months of life. This study evaluates the relationship between survival in patients with advanced cancer and longitudinal assessment of anxiety, depression, fatigue, pain interference, and/or physical function using the US National Institute of Health Patient Reported Outcomes Information System.

Methods

Mixed-effects models were used to evaluate patient-reported outcome trajectories over time among patients with advanced loco-regional or metastatic cancer receiving care in a hospital-based palliative care clinic. Cox regression analysis was used to assess the statistical significance of differences in the probability of survival associated with patient-reported outcome scores.

Results

A total of 472 patients completed 1992 assessments during the 18-month study period. Longitudinal scores for fatigue, pain interference, and physical function demonstrated statistically significant non-linear trajectories. Scores for depression, fatigue, pain interference, and physical function were highly statistically significant predictors of survival (p < 0.01). Clinically meaningful differences in the probability of survival were demonstrated between patients with scores at the 25th vs. 75th percentiles, with absolute differences in survival at 6 and 12 months after assessment from 10 to 18 percentage points.

Conclusions

Patient-reported outcomes can be used to reliably estimate where patients are along the trajectory of deteriorating health status leading toward the end of life, and for identifying patients with declining symptoms in need of referral to palliative care or more aggressive symptom management.
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Metadata
Title
Longitudinal patterns of cancer patient reported outcomes in end of life care predict survival
Authors
George J. Stukenborg
Leslie J. Blackhall
James H. Harrison
Patrick M. Dillon
Paul W. Read
Publication date
01-05-2016
Publisher
Springer Berlin Heidelberg
Published in
Supportive Care in Cancer / Issue 5/2016
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-015-3024-y

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