Does routine symptom screening with the Edmonton Symptom Assessment System (ESAS) decrease emergency department visits in breast cancer patients undergoing adjuvant chemotherapy?
Bibliographic record
Abstract
6514 Background: In 2007 the provincial cancer agency in Ontario, Canada initiated a wide scale program to screen for symptoms in the cancer population using the Edmonton Symptom Assessment Scale (ESAS). The purpose of this study is to evaluate the impact of screening with ESAS on emergency department (ED) visit rates in women with breast cancer receiving adjuvant chemotherapy (CT). Methods: This retrospective cohort study used linked administrative health care data from across the province of Ontario, Canada. The cohort included all women aged ≥18 who were diagnosed with stage I-III breast cancer between January 2007 and December 2009 and received adjuvant CT within 6 months of diagnosis. Using a recurrent event model to adjust for covariates, we examined the association of screening with ESAS at a clinic visit on the ED visit rate. Results: 8,359 women were included. Approximately one third were screened with ≥1 ESAS during their chemotherapy. The rate of ED visits was 35% lower among patients screened with ESAS compared to those not screened. For each additional ESAS assessment there was a 19% decreased rate of ED visits. Conclusions: Our results demonstrate that screening with ESAS is associated with decreased ED visits. To our knowledge this is the first report on the effectiveness of routinely documenting patient-reported symptoms on ED visits, in a real world setting. Adjusted model results showing relative rate (RR) of ED visits for exposure to ESAS during chemotherapy either as a dichotomous or continuous variable (also adjusted for region and number of clinic visits). Variable Value Adjusted ESAS (Y/N) ESAS (Continuous) RR LCL UCL RR LCL UCL Age Continuous 1.00 1.00 1.00 1.00 1.00 1.00 Income quintile 1 1.04 0.97 1.11 1.04 0.97 1.11 2 1.03 0.97 1.10 1.03 0.97 1.10 3 1.04 0.97 1.10 1.04 0.97 1.10 4 1.02 0.96 1.08 1.02 0.96 1.08 5 1 1 Charlson 0 1 1 1 1.04 0.97 1.11 1.04 0.97 1.12 Stage I 1 1 II 1.02 0.96 1.07 1.02 0.96 1.07 II 1.06 0.99 1.13 1.05 0.99 1.13 Unknown 1.12 1.01 1.24 1.12 1.01 1.23 Docetaxol regimen Yes 1.41 1.32 1.51 1.40 1.31 1.50 No 1 1 ESAS exposure Yes 0.65 0.61 0.70 - - - No continuous - - - 0.81 0.77 0.84 Abbreivations: LCL, lower confidence limit; UCL, upper confidence limit.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 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) | 0.001 | 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 source (direct Gemma or distilled Codex), 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".