Patient-reported outcomes (PROs) is a new term describing the longstanding work of oncology nurses in assessing, documenting, and managing the symptoms and side-effects patients with cancer experience. Oncology nurses are experts in understanding the multiple and often overwhelming physical, emotional, social, functional, and spiritual impacts of cancer and its treatment. The past decade has seen a newfound appreciation amongst oncology clinicians in routinely capturing PROs throughout cancer care.
Hospital systems, clinicians, and researchers use a variety of symptom PROs to assess cancer symptoms, limiting the ability to compare sets or provide standard recommendations to implement symptom management. Developing robust, patient-centered PROs that can be broadly disseminated can facilitate oncology nurses in their work understanding and treatment symptoms.
A nurse researcher at the University of Calgary, Canada, Linda Watson, PhD, BScN, recently published findings using a patient-engaged measure throughout an ambulatory cancer care center. The article, published in the Journal of Clinical Oncology – Oncology Practice, describes the multi-step approach to collecting stakeholder input and then validating a cancer-specific PRO.
The researchers adjusted the Edmonton Symptom Assessment Scale – revised (ESAS), which is one of the most common symptom assessments used clinically and in research. It asks patients to rate 9 common symptoms on a scale of 0 (not present) to 10 (most severe). Item responses are classified by severity: low (0-3), 4-6 (moderate), and 7-10 (severe).
Twenty-five stakeholder sessions were held – including patients and advocates – to consider a more comprehensive, specific list of symptoms relevant across cancer types. The researchers also summarized items from the problem checklist (commonly used in Canada and the US during distress screening) to develop 1 comprehensive tool. Then, the researchers conducted statistical tests within a sample of 400 patients at their cancer center to measure the reliability, stability, and strength of the revised ESAS.
The final cancer-specific ESAS assessed 15 symptoms: pain, tiredness, drowsiness, nausea, lack of appetite, shortness of breath, depression, anxiety, well-being, diarrhea, constipation, numbness and tingling, sleep problems, thinking problems, and mobility problems. The statistical tests indicated that this assessment was as robust as prior versions while also showing more consistency and describing more variability between patients. This is essential to ensuring the ESAS-Cancer can be continually administered among patients and pick up changes over time.
Symptom assessments help ensure patient side-effects are continually assessed and treated. While oncology nurses are leaders in symptom management, without routine systems to collect PROs, patient quality of life and communication suffer. Some cancer centers have moved to collecting electronic PROs from patients and immediately notifying the care team of any severe symptoms. If symptom assessments like the ESAS-Cancer can facilitate such conversations and proactive symptom management, then nursing can promptly provide evidence-based symptom recommendations and referrals.
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