Abstract
Background
Symptom burden, as measured by patient-reported outcome (PRO) metrics, may have prognostic value in various cancer populations, but remains underreported. The aim of this project was to determine the predictive impact of preoperative patient-reported symptom burden on readiness to return to intended oncologic therapy (RIOT) after oncologic liver resection.
Methods
Preoperative factors, including anthropometric analysis of sarcopenia, were collected for patients undergoing oncologic liver resection from 2015 to 2018. All patients reported their preoperative symptom burden using the MD Anderson Symptom Inventory, Gastrointestinal version (MDASI-GI). Time to RIOT readiness was compared using standard statistics.
Results
Preoperative symptom burden was measured in 107 consecutive patients; 52% had at least one moderate symptom score and 21% reported at least one severe score. Highest rated symptoms were fatigue, disturbed sleep, and distress. For patients reporting a severe preoperative symptom burden, the median time to RIOT readiness was 35 days (interquartile range [IQR] 28–42), compared with 21 days (IQR 21–28) for those without severe symptoms (p < 0.001). On multivariable analysis, severe preoperative symptom burden was independently associated with longer time to RIOT readiness (estimate +7.5 days, 95% confidence interval 2.6–12.3; p = 0.002).
Conclusions
Preoperative symptom burden has a substantial impact on time to RIOT readiness, leading to, on average, a 7-day delay in RIOT readiness compared with patients without severe preoperative symptoms. Identifying and targeting severe preoperative symptoms may hasten recovery and improve time to necessary adjuvant therapies.
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Acknowledgment
The authors thank Brigitte M. Taylor (Department of Surgical Oncology, MD Anderson Cancer Center) for administrative assistance in the preparation of this manuscript.
Funding
Dr. Heather Lillemoe is supported by National Institutes of Health grant T32CA009599 and MD Anderson Cancer Center support Grant P30 CA016672. Dr. Xin Shelley Wang is supported by Grants from the US National Cancer Institute (R01 CA205146).
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Lillemoe, H.A., Marcus, R.K., Kim, B.J. et al. Severe Preoperative Symptoms Delay Readiness to Return to Intended Oncologic Therapy (RIOT) After Liver Resection. Ann Surg Oncol 26, 4548–4555 (2019). https://doi.org/10.1245/s10434-019-07719-8
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DOI: https://doi.org/10.1245/s10434-019-07719-8