Characteristics and predictors of pain in patients with newly diagnosed and relapsed acute leukemia (AL).
Bibliographic record
Abstract
e21633 Background: AL is a hematopoietic stem cell malignancy associated with substantial morbidity and mortality. The prevalence, correlates and causes for pain in this population have not been well studied. We present the results of a large cross-sectional study of pain in individuals with AL. Methods: Patients with newly-diagnosed or recently-relapsed AL admitted to a large tertiary cancer center completed the Memorial Symptom Assessment Scale (MSAS, which has subscales of prevalence, severity, frequency and distress, with ratings of 0 = none, 1 = mild, 2 = moderate, 3 = severe, 4 = very severe). Demographic information, and disease and treatment variables were recorded. Two raters completed chart reviews in duplicate (with discussion of discordant results) for patients with severe pain (MSAS severity ≥3/4) to assess the site of pain. Results: A total of 362 patients were recruited from January 2008 to October 2013: 249 (68.8%) with AML, 80 (22.1%) ALL and 33 (9.1%) APL. Of these, 326 (90.1%) were newly diagnosed and 36 (9.9%) had relapsed disease; 346 (95.6%) were treated with (re)induction chemotherapy. Of 360 who completed the MSAS, pain was reported in 174 (48.3%), of whom 34.4% scored ≥3/4 on severity, 43.1% on frequency, and 44.3% on distress related to the pain. On multivariable analysis, patients reporting pain were more likely to be younger (OR 0.98 old vs young, p < 0.001), and to have ALL (OR 0.57 AML vs ALL, p < 0.05); duration of illness, gender, education, income and treatment intensity were not associated with pain. Pain was correlated with difficulty sleeping, worrying, difficulty concentrating, and feeling sad, nervous or irritable (all p < 0.001). Of the 60 patients reporting severe pain (≥3/4), its site was identified in 53 (88.3%). The most common sites were oropharynx (29.7%), head (18.9%), abdomen (14.9%) and musculoskeletal (12.2%). Only 1.1% (4/362) of the cohort was referred to the palliative care/symptom control team over the month prior to or following assessment. Conclusions: Pain is a frequent and distressing symptom in patients with newly diagnosed or relapsed AL. Further research is needed to assess the efficacy of supportive care interventions in this population.
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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 | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| 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) | 0.002 | 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".