Longitudinal symptom burden among early phase cancer clinical trial (EP-CT) participants.
Bibliographic record
Abstract
412 Background: Individuals with cancer participating in EP-CTs often experience burdensome symptoms. However, little is known about their changes in symptom burden over time and how they relate to other patient-reported outcomes (PROs) and clinical outcomes. Methods: We prospectively enrolled adults with cancer participating in EP-CTs at Massachusetts General Hospital from 4/2021-1/2023. Participants completed monthly surveys throughout EP-CT that assessed symptoms (Edmonton Symptom Assessment System [ESAS]), quality of life (QOL; Functional Assessment of Cancer Therapy-General [FACT-G]), hope (Herth Hope Index), depression/anxiety symptoms (Patient Health Questionnaire 4 [PHQ4]), and financial wellbeing (COST tool, higher scores indicate greater financial wellbeing). We used linear mixed models to assess associations of symptom burden over time with baseline PROs and applied Cox regression to assess correlations of symptom scores from baseline to months 1, 2, and 3 with clinical outcomes (hospitalizations, time on trial, overall survival). Results: We enrolled 196 participants (median age = 63.3 [range: 31.8-88.6], 58% female, median time on trial = 60 days), with the most common cancer types gastrointestinal (34%) and breast (20%). We found no significant associations among patient characteristics and longitudinal ESAS scores. Higher baseline FACT-G emotional wellbeing (B = -.01, p = .015) correlated with improvement in longitudinal ESAS total scores. Higher baseline PHQ anxiety (B = .19, p = .035) correlated with worsening ESAS total scores. Higher baseline QOL (B = -.01, p < .001), FACT-G physical wellbeing (B = -.02, p = .003), financial wellbeing (B = -.01, p = .046), and hope (B = -.03, p < .001) scores were associated with improvement in ESAS psychological scores over time. Higher baseline PHQ depression (B = .86, p = .001) and anxiety (B = .09, p < .001) were associated with worsening ESAS psychological scores over time. The table displays associations of changes in ESAS from baseline to months 1, 2, and 3 with clinical outcomes; findings demonstrate that worsening ESAS scores from baseline to month 2 correlated with higher hospitalization risk, shorter time on trial, and worse survival. Conclusions: In this study of EP-CT participants, we found associations of baseline QOL, financial wellbeing, hope, and anxiety with symptom burden over time as well as associations between change in symptom burden and clinical outcomes. Changes from ESAS baseline to month 2 correlated with higher healthcare use, shorter time on trial, and worse survival. Future efforts to enhance EP-CT participants’ outcomes should seek to understand the underlying mechanisms of these findings. Longitudinal ESAS Hospitalization Time on Trial Survival HR P HR P HR P Baseline to Month 1 (n=171) 1.02 .106 1.01 .193 1.01 .219 Baseline to Month 2 (n=129) 1.03 .014 1.02 .017 1.02 .025 Baseline to Month 3 (n=86) 1.00 .841 1.02 .048 1.01 .364
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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 | 0.008 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 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".