Combined cancer patient–reported symptom and health utility tool for routine clinical implementation: a real-world comparison of the ESAS and EQ-5D in multiple cancer sites

  • M. Moskovitz Princess Margaret Cancer Centre, University of Toronto
  • K. Jao Princess Margaret Cancer Centre, University of Toronto, Hôpital du Sacré-Coeur, McGill University
  • J. Su Ontario Cancer Institute, Princess Margaret Cancer Centre, University of Toronto
  • M. C. Brown Princess Margaret Cancer Centre, University of Toronto
  • H. Naik Princess Margaret Cancer Centre, University of Toronto, University of British Columbia
  • L. Eng Princess Margaret Cancer Centre, University of Toronto
  • T. Wang Princess Margaret Cancer Centre, University of Toronto
  • J. Kuo Princess Margaret Cancer Centre, University of Toronto
  • Y. Leung Princess Margaret Cancer Centre, University of Toronto,
  • W. Xu Ontario Cancer Institute, Princess Margaret Cancer Centre, University of Toronto
  • N. Mittman Cancer Care Ontario, Odette Cancer Centre, University of Toronto
  • L. Moody Cancer Care Ontario
  • L. Barbera Cancer Care Ontario, Odette Cancer Centre, University of Toronto
  • G. Devins Supportive Care, Princess Margaret Cancer Centre, University of Toronto
  • M. Li Supportive Care, Princess Margaret Cancer Centre, University of Toronto
  • D. Howell Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Lawrence Bloomberg School of Nursing
  • G. Liu Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Dalla Lana School of Public Health
Keywords: Value in cancer care, patient-reported outcomes

Abstract

Background We assessed whether the presence and severity of common cancer symptoms are associated with the health utility score (hus) generated from the EQ-5D (EuroQol Research Foundation, Rotterdam, Netherlands) in patients with cancer and evaluated whether it is possible pragmatically to integrate routine hus and symptom evaluation in our cancer population.

Methods Adult outpatients at Princess Margaret Cancer Centre with any cancer were surveyed cross-sectionally using the Edmonton Symptom Assessment System (esas) and the EQ-5D-3L, and results were compared using Spearman correlation coefficients and regression analyses.

Results Of 764 patients analyzed, 27% had incurable disease. We observed mild-to-moderate correlations between each esas symptom score and the hus (Spearman coefficients: –0.204 to –0.416; p < 0.0001 for each comparison), with the strongest associations being those for pain (R = –0.416), tiredness (R = –0.387), and depression (R =-0.354). Multivariable analyses identified pain and depression as highly associated (both p < 0.0001) and tiredness as associated (p = 0.03) with the hus. The ability of the esas to predict the hus was low, at 0.25. However, by mapping esas pain, anxiety, and depression scores to the corresponding EQ-5D questions, we could derive the hus using partial esas data, with Spearman correlations of 0.83–0.91 in comparisons with direct EQ-5D measurement of the hus.

Conclusions The hus derived from the EQ-5D-3L is associated with all major cancer symptoms as captured by the esas. The esas scores alone could not predict EQ-5D scores with high accuracy. However, esas-derived questions assessing the same domains as the EQ-5D-3L questions could be mapped to their corresponding EQ-5D questions to generate the hus, with high correlation to the directly measured hus. That finding suggests a potential approach to integrating routine symptom and hus evaluations after confirmatory studies.


Author Biographies

M. Moskovitz, Princess Margaret Cancer Centre, University of Toronto
Medical Oncology and Hematology, Department of Medicine
K. Jao, Princess Margaret Cancer Centre, University of Toronto, Hôpital du Sacré-Coeur, McGill University
Medical Oncology and Hematology, Department of Medicine
J. Su, Ontario Cancer Institute, Princess Margaret Cancer Centre, University of Toronto
Department of Biostatistics
M. C. Brown, Princess Margaret Cancer Centre, University of Toronto
Medical Oncology and Hematology, Department of Medicine
H. Naik, Princess Margaret Cancer Centre, University of Toronto, University of British Columbia
Medical Oncology and Hematology, Department of Medicine
L. Eng, Princess Margaret Cancer Centre, University of Toronto
Medical Oncology and Hematology, Department of Medicine
T. Wang, Princess Margaret Cancer Centre, University of Toronto
Faculty of Pharmacy, Medical Oncology and Hematology, Department of Medicine
J. Kuo, Princess Margaret Cancer Centre, University of Toronto
Medical Oncology and Hematology, Department of Medicine
Y. Leung, Princess Margaret Cancer Centre, University of Toronto,
Supportive Care
W. Xu, Ontario Cancer Institute, Princess Margaret Cancer Centre, University of Toronto
Department of Biostatistics
N. Mittman, Cancer Care Ontario, Odette Cancer Centre, University of Toronto
Department of Psychiatry
L. Barbera, Cancer Care Ontario, Odette Cancer Centre, University of Toronto
Department of Psychiatry
G. Devins, Supportive Care, Princess Margaret Cancer Centre, University of Toronto
Department of Psychiatry
G. Liu, Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Dalla Lana School of Public Health

Department of Medical Biophysics, and Institute
of Medical Science, Department of Epidemiology, Department of Medicine

Published
2019-12-20
How to Cite
Moskovitz, M., Jao, K., Su, J., Brown, M. C., Naik, H., Eng, L., Wang, T., Kuo, J., Leung, Y., Xu, W., Mittman, N., Moody, L., Barbera, L., Devins, G., Li, M., Howell, D., & Liu, G. (2019). Combined cancer patient–reported symptom and health utility tool for routine clinical implementation: a real-world comparison of the ESAS and EQ-5D in multiple cancer sites. Current Oncology, 26(6). https://doi.org/10.3747/co.26.5297
Section
Integrative Oncology