Comparing Symptom Burden in Patients with Metastatic and Nonmetastatic Cancer
Bibliographic record
Abstract
BACKGROUND: Symptoms of patients with advanced cancer have been extensively studied, but less attention has been paid to the symptomatology of patients with localized disease. We compared the symptom burden of outpatients with cancer, either metastatic or localized disease, seen in a palliative care comanagement clinic. METHODS: We conducted a retrospective, cross-sectional study assessing patient symptoms with multiple patient surveys, including a modified Edmonton Symptom Assessment Survey (to assess pain, fatigue, anxiety, depression, and nausea), along with a spiritual well-being screen and questions about relationships and quality of life. Consecutive patients at a comprehensive cancer center completed the surveys prior to their first visit to an outpatient palliative care clinic providing palliative care concurrently with the patients' oncologic treatments. Patients were referred by their oncologist, radiation oncologist, oncologic surgeon, or primary care physician without respect to their stage or prognosis. Statistical analyses used were χ(2), Fisher's exact test, Student's t test, and multivariate linear regression. Significance was taken as p<0.05. RESULTS: Two hundred and five patients were included in this study. One hundred and twenty-seven patients (62%) had metastatic cancer and 78 (38%) had nonmetastatic cancer. The characteristics of the two study groups were similar with regard to age, sex, ethnicity, language, religion, partnership status, and insurance status. Patients with metastatic disease and localized disease had similar mean symptom burden and mean individual symptom intensity for all symptoms evaluated except for nausea, which was worse in patients with metastatic disease (3.4 versus 2.5, p=0.0028). Nausea was also worse in younger patients. CONCLUSION: Among patients referred to a cancer center outpatient palliative care clinic, symptom burden is similar in patients with localized and metastatic disease. Even patients with relatively good prognoses may nevertheless have significant symptom burdens in physical, emotional, and existential domains. The palliative care needs of all patients must be assessed, regardless of stage or prognosis.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".