K.W. Blackburn1, A. Roach2, E.A. Carasco Barcenas3, D.I. Cope1, A. Wood3, J.M. Sanchez Guzman3, G. Van Buren3, D.J. Erstad3, W.E. Fisher3, E. Camp3 1Baylor College of Medicine, School Of Medicine, Houston, TX, USA 2Northeast Ohio Medical University, College Of Medicine, Rootstown, OH, USA 3Baylor College of Medicine, Division Of Surgical Oncology, Houston, TX, USA
Introduction: Psychosocial distress is common in cancer patients especially those with pancreatobilliary tumors. However, the prevalence and severity of symptoms has not been well described. The Edmonton Symptom Assessment Scale (ESAS) is commonly used as a multidimensional tool which measures both physical symptoms (nausea, vomiting, etc.) and emotional symptoms (depression, family distress, etc.). To address Commission on Cancer requirements, our cancer center began measuring distress using the ESAS in all new cancer patients starting in 2021. We hypothesized that cancer patients would demonstrate greater distress than those with benign disease.
Methods: 238 patients were included in the study—each patient filled out a pre-operative ESAS between the years 2022 and 2024. ESAS scores were completed during a clinic visit by the patient or a family member. The ESAS includes 13 scales: pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, constipation, dyspnea, wellbeing, sleep quality, family distress, and spiritual distress—each on a scale from 1 to 10. We combined these metrics into a physical distress score (out of 80), an emotional distress score (out of 40), and a total symptom distress score (out of 130). Numeric variables were presented as median [Q1, Q3] and were compared using a Wilcoxon rank-sum test. Categorical variables were presented as count (%) and compared using a Pearson’s chi-squared test.
Results: For the 238 patients included in the study, 72 (30.3%) had benign disease and 166 (69.7%) had malignancy. In this patient cohort, the most common operation was a Whipple procedure (147 (61.8%)), with 77 (32.4%) receiving a distal pancreatectomy and 14 (5.8%) receiving another operation. In our cohort, the symptoms reported with the greatest severity in the cohort was tiredness (3 [0,5]) and poor sleep quality (3 [1,5]), whereas spiritual distress (0 [0, 0]) and dyspnea (0 [0,1]) were rarely reported. The median physical distress score was 12 [3,21], emotional distress score was 1 [0,6], and total distress score was 16 [5,30]. Patients receiving neoadjuvant chemotherapy were more likely to report concerns with appetite (58.8% vs. 36.7%, P=.002). When comparing patients with malignant disease versus those with benign disease, there was no significant difference in physical (12 [4,21] vs. 11 [3, 21]; P=.8), emotional (1 [0,6] vs. 1 [0,8]; P=.4), or total distress prior to surgery (16 [6,30] vs. 17 [5,31]; P=.9).
Conclusion: In this study we show the preliminary results of the use of the Edmonton Symptom Assessment Scale (ESAS) to screen patients for distress prior to receiving pancreatic surgery. While patients receiving pancreatic surgery tend to have a significant disease burden, they often report low levels of distress, especially emotional distress. In addition, this score can be used as a mechanism to personalize treatment for patients based on their unique symptomatology—either physical or emotional.