ASO Author Reflections: Palliative Chemotherapy for Upper Gastrointestinal Cancer: Balancing Hope, Reality, Survival, an
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: Palliative Chemotherapy for Upper Gastrointestinal Cancer: Balancing Hope, Reality, Survival, and Symptoms Shaila J. Merchant, MSc, MHSc, MD1,3, and Christopher M. Booth, MD2,3 1
Division of General Surgery and Surgical Oncology, Kingston Health Sciences Centre, Queen’s University, Kingston, ON, Canada; 2Division of Medical Oncology, Queen’s University, Kingston, ON, Canada; 3Cancer Care and Epidemiology, Queen’s University, Kingston, ON, Canada
PAST Palliative chemotherapy (PC) is associated with a modest survival benefit in patients with incurable esophageal and gastric cancer; however, changes in symptom profile during treatment are not well described, particularly in patients seen in routine practice. Understanding the trajectory of symptoms during treatment may lead to improved patient–provider discussions surrounding the initiation of PC. In the current study, we describe changes in patient-reported symptoms during PC. Symptoms were assessed using the Edmonton Symptom Assessment System (ESAS), a validated screening tool developed to assist healthcare providers in the assessment of nine symptoms commonly observed in patients with cancer, including pain, tiredness, drowsiness, nausea, lack of appetite, depression, anxiety, shortness of breath, and lack of well1 being. , 2 PRESENT We conducted a population-based study in the Canadian province of Ontario of all patients who were diagnosed with esophageal or gastric cancer during 2012–2017 and who received PC, and with at least one recorded ESAS 3 score. Of 1900 patients in Ontario who received PC for
Ó Society of Surgical Oncology 2020 First Received: 30 September 2020 Accepted: 4 October 2020 S. J. Merchant, MSc, MHSc, MD e-mail: [email protected]
this indication, 79% (1497/1900) had one or more recorded ESAS scores and subsequently formed the study cohort. In this cohort, we observed that younger patients were more likely to report moderate–severe symptoms in pain and nausea, and females were more likely to report moderate– severe symptoms in anxiety/depression while receiving treatment. Furthermore, anxiety/depression symptoms deteriorated for 35% of patients receiving PC. FUTURE The survival benefit from PC for esophageal and gastric cancer is modest at best, and decision making surrounding the initiation of treatment must consider quality and quantity of life. Patients in routine practice report substantial symptom burden and addressing expectations regarding these symptoms is critical when considering initiation of treatment. Patients often ask, ‘‘how will they feel on chemotherapy’’. Until now, few data from routine practice were available to answer that question. In this study, we report that patient-reported symptoms do change while receiving PC, including potentially modifiable symptoms such as pain, nausea, and anxiety/depression, which are more severe in specific groups and worsen during treatment. This information has implications for patient–provider discussions surrounding the initiat
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