Does routine symptom screening with ESAS decrease ED visits in breast cancer patients undergoing adjuvant chemotherapy?

Support Care Cancer (2015) 23:30253032 DOI 10.1007/s00520-015-2671-3

ORIGINAL ARTICLE

Does routine symptom screening with ESAS decrease ED visits in breast cancer patients undergoing adjuvant chemotherapy?

L. Barbera & R. Sutradhar & D. Howell & J. Sussman &

H. Seow & D. Dudgeon & C. Atzema & C. Earle & A. Husain &

Y. Liu & M. K. Krzyzanowska

Received: 2 December 2014 /Accepted: 15 February 2015 /Published online: 26 February 2015 # Springer-Verlag Berlin Heidelberg 2015

AbstractBackground 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.

Patients and 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 IIII breast cancer between January 2007 and December 2009 and received adjuvant chemotherapy within 6 months of diagnosis.

Using an adjusted recurrent event model, we examined the association of screening with ESAS at a clinic visit on the ED visit rate.

Results The relative rate of ED visits was 0.57 when prior ESAS screening occurred compared to when it did not. The relative rate of ED visits was 0.83 when the prior number of ESAS screens was modeled as a continuous variable. Alternatively stated, the rate of ED visits was 43 % lower among patients previously screened with ESAS compared to those not previously screened. For each additional prior ESAS assessment, there was a 17 % decreased rate of ED visits.

Conclusions Our results demonstrate that screening with ESAS is associated with decreased ED visits. To our

An abstract of this work was presented at the 2014 ASCO Annual Meeting.

L. Barbera (*)

Odette Cancer Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canadae-mail: [email protected]

L. BarberaDepartment of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada

L. Barbera : R. Sutradhar : H. Seow : C. Atzema : C. Earle : Y. Liu :

M. K. KrzyzanowskaInstitute for Clinical Evaluative Sciences, Toronto, Ontario, Canada

R. SutradharDepartment of Biostatistics, Dalla Lana...