Objective This study aims to test the acceptance, feasibility, and usefulness of the Arabic version of the revised Edmonton Symptom AssesSment System （ESAS-r） among Egyptian patients with advanced cancer and to comp...Objective This study aims to test the acceptance, feasibility, and usefulness of the Arabic version of the revised Edmonton Symptom AssesSment System （ESAS-r） among Egyptian patients with advanced cancer and to compare the rates of symptoms documented by patients and physicians. Methods Between August 2014 and February 2015, a total of 140 patients at Ain Shams University Hospitals in Cairo, Egypt received the Arabic version of the ESAS-r. For each patient, the ESAS-r was completed twice, first by the treating physician （as part of the basic assessment） and a second time by the patient, with a maximum of 2 hours between the two assessments. An additional survey was included to assess patients＇ acceptance of the survey and their preferences. Results Out of 140 enrolled patients in the study, 11 patients refused to complete the questionnaire, and 10 patients were excluded due to incomplete records in their medical records. Complete data was retrieved for 119 patients who were included for further analyses. The 78 （65%） patients declared that the test was clear and easy to complete. They were able to answer the test without help. Collectively, tiredness and sense of well-being were the most commonly encountered symptoms in ratings obtained by both patients and physicians. Tiredness was the only symptom showing a significant difference between the two rating methods, patient-rated scores being higher （P = 0.032）. Cronbach＇s alpha showed that both tests com- pleted by the physician and the patients were internally consistent： the physician-rated test had a coefficient of 0.877, and the patient-rated test had a coefficient of 0.863. All ESAS scores had good internal consis- tency, with a Cmnbach＇s alpha coefficient of 0.88. The internal consistency remained high after removal of individual symptom scores, with Cronbach＇s alpha coefficients ranging from 0.823 to 0.902, indicating that no individual question had undue influence on the total ESAS score. Conclusion The ESAS-r was easily understood by and applicable to patients. There was no significant discrepancy in the rates of symptoms reported by the patients and physicians, apart from tiredness. Based on this, the test could be applied on a larger scale with in-home patients. This test can be cost-effective and can decrease the number of hospital visits among advanced cancer patients in need of supportive treat- ment rather than active cancer therapy.展开更多
Background： Erythropoiesis-stimulating agents （ESAs） are widely used in the management of anemia in cancer patients. Despite their apparent effectiveness, recent studies have suggested that ESAs could result in ser...Background： Erythropoiesis-stimulating agents （ESAs） are widely used in the management of anemia in cancer patients. Despite their apparent effectiveness, recent studies have suggested that ESAs could result in serious adverse events and even higher mortality. The aim of the current study was to evaluate the benefits and risks of ESAs in the management of cancer patients with anemia using a recta-analysis. Methods： The initial literature search covered Medline, PubMed, Embase, and the Cochrane Center Register of Controlled Trials, and identified 1,569 articles. The final meta-analysis included eight randomized controlled trials （n=2,387） in cancer patients with 〈11 g/dL hemoglobin （Hb） at the baseline and target Hb （for stopping ESA treatment） at no more than 13 g/dL. The assessment measures included Hb response, blood transfusion rate and adverse events that included venous thromboemblism （VTE）, hypertension, and on-study mortality. The results are expressed as pooled odds ratio （OR）. Publication bias was assessed using funnel plot analysis. Results： ESAs significantly increased the Hb concentration [OR 7.85, 95% confidence interval （CI）： 5.85 to 10.53, P〈O.O01] and reduced the red blood cell （RBC） transfusion rate （OR 0.52, 95% CI： 0.42 to 0.65, P〈0.001）. ESAs did not increase the accumulated adverse events （OR 0.95, P=0.82）, or the on-study mortality （OR 1.09, P=0.47）. Conclusions： ESAs are not associated with increased frequency of severe adverse events in anemic cancer patients when the target Hb value is no more than 13 g/dL.展开更多
文摘Objective This study aims to test the acceptance, feasibility, and usefulness of the Arabic version of the revised Edmonton Symptom AssesSment System （ESAS-r） among Egyptian patients with advanced cancer and to compare the rates of symptoms documented by patients and physicians. Methods Between August 2014 and February 2015, a total of 140 patients at Ain Shams University Hospitals in Cairo, Egypt received the Arabic version of the ESAS-r. For each patient, the ESAS-r was completed twice, first by the treating physician （as part of the basic assessment） and a second time by the patient, with a maximum of 2 hours between the two assessments. An additional survey was included to assess patients＇ acceptance of the survey and their preferences. Results Out of 140 enrolled patients in the study, 11 patients refused to complete the questionnaire, and 10 patients were excluded due to incomplete records in their medical records. Complete data was retrieved for 119 patients who were included for further analyses. The 78 （65%） patients declared that the test was clear and easy to complete. They were able to answer the test without help. Collectively, tiredness and sense of well-being were the most commonly encountered symptoms in ratings obtained by both patients and physicians. Tiredness was the only symptom showing a significant difference between the two rating methods, patient-rated scores being higher （P = 0.032）. Cronbach＇s alpha showed that both tests com- pleted by the physician and the patients were internally consistent： the physician-rated test had a coefficient of 0.877, and the patient-rated test had a coefficient of 0.863. All ESAS scores had good internal consis- tency, with a Cmnbach＇s alpha coefficient of 0.88. The internal consistency remained high after removal of individual symptom scores, with Cronbach＇s alpha coefficients ranging from 0.823 to 0.902, indicating that no individual question had undue influence on the total ESAS score. Conclusion The ESAS-r was easily understood by and applicable to patients. There was no significant discrepancy in the rates of symptoms reported by the patients and physicians, apart from tiredness. Based on this, the test could be applied on a larger scale with in-home patients. This test can be cost-effective and can decrease the number of hospital visits among advanced cancer patients in need of supportive treat- ment rather than active cancer therapy.
基金supported by the Development Projects of Science and Technology of Shandong Province, China (2012GGE27073)
文摘Background： Erythropoiesis-stimulating agents （ESAs） are widely used in the management of anemia in cancer patients. Despite their apparent effectiveness, recent studies have suggested that ESAs could result in serious adverse events and even higher mortality. The aim of the current study was to evaluate the benefits and risks of ESAs in the management of cancer patients with anemia using a recta-analysis. Methods： The initial literature search covered Medline, PubMed, Embase, and the Cochrane Center Register of Controlled Trials, and identified 1,569 articles. The final meta-analysis included eight randomized controlled trials （n=2,387） in cancer patients with 〈11 g/dL hemoglobin （Hb） at the baseline and target Hb （for stopping ESA treatment） at no more than 13 g/dL. The assessment measures included Hb response, blood transfusion rate and adverse events that included venous thromboemblism （VTE）, hypertension, and on-study mortality. The results are expressed as pooled odds ratio （OR）. Publication bias was assessed using funnel plot analysis. Results： ESAs significantly increased the Hb concentration [OR 7.85, 95% confidence interval （CI）： 5.85 to 10.53, P〈O.O01] and reduced the red blood cell （RBC） transfusion rate （OR 0.52, 95% CI： 0.42 to 0.65, P〈0.001）. ESAs did not increase the accumulated adverse events （OR 0.95, P=0.82）, or the on-study mortality （OR 1.09, P=0.47）. Conclusions： ESAs are not associated with increased frequency of severe adverse events in anemic cancer patients when the target Hb value is no more than 13 g/dL.
