Longitudinal Symptom Burden Trajectories in a Population-Based Cohort of Women with Metastatic Breast Cancer: A Group-Based Trajectory Modeling Analysis

Current Oncology

Rahim Moineddin¹  Suman Budhwani²  Walter P. Wodchis³  Camilla Zimmermann⁴  Doris Howell⁴ 

[1] Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada;Institute for Health System Solutions and Virtual Care, Women’s College Hospital, Toronto, ON M5S 1B2, Canada;Institute of Clinical Evaluative Sciences, Toronto, ON M4N 3M5, Canada;Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C1, Canada;

关键词: breast neoplasms;    neoplasm metastasis;    palliative care;    symptom assessment;    syndrome;    cohort studies;   

DOI  :  10.3390/curroncol28010087

来源: DOAJ

【 摘 要 】

Understanding the symptom burden trajectory for metastatic breast cancer patients can enable the provision of appropriate supportive care for symptom management. The aim of this study was to describe the longitudinal trajectories of symptom burden for metastatic breast cancer patients at the population-level. A cohort of 995 metastatic breast cancer patients with 16,146 Edmonton Symptom Assessment System (ESAS) assessments was constructed using linked population-level health administrative databases. The patient-reported ESAS total symptom distress score (TSDS) was studied over time using group-based trajectory modeling, and covariate influences on trajectory patterns were examined. Cohort patients experienced symptom burden that could be divided into six distinct trajectories. Patients experiencing a higher baseline TSDS were likely to be classified into trajectory groups with high, uncontrolled TSDS within the study follow-up period (χ² (1, N = 995) = 136.25, p < 0.001). Compared to patients classified in the group trajectory with the highest relative TSDS (Group 6), patients classified in the lowest relative TSDS trajectory group (Group 1) were more likely to not have comorbidities (97.34% (for Groups 1–3) vs. 91.82% (for Group 6); p < 0.05), more likely to receive chemotherapy (86.52% vs. 80.50%; p < 0.05), and less likely to receive palliative care (52.81% vs. 79.25%; p < 0.0001). Receiving radiotherapy was a significant predictor of how symptom burden was experienced in all identified groups. Overall, metastatic breast cancer patients follow heterogeneous symptom burden trajectories over time, with some experiencing a higher, uncontrolled symptom burden. Understanding trajectories can assist in establishing risk-stratified care pathways for patients.

【 授权许可】

Unknown