Prospective assessment of targeted symptom management on supportive care in cancer: An observational cohort study.
Authors: Raffaele Giusti , Marinelli Daniele , Fumi Guglielmo , Toccaceli Paolo , Ravoni Giulio , Colpani Emilia , Vacca Denise , Siciliano Maria anna , Fiorani Claudia , Porzio Giampiero 
Published: June 2024

e24073

Background: In advanced cancer, patients may experience treatment-related symptoms or disease burden, necessitating multiple supportive care pharmacotherapies. However, managing these symptoms can lead to complex polypharmacy, potentially resulting in inefficacies or toxicities due to pharmacogenetic interactions. Our study focuses on targeting the most impactful symptom to streamline pharmacotherapy, potentially reducing the need for extensive polypharmacotherapy. By prioritizing management of this "target symptom”, our study seeks to optimize improve overall symptom relief and reduce the need for extensive polypharmacotherapy. Methods: Upon initial palliative care evaluation, the PERSONS score (Pain, Eating/cachexia, Rehabilitation/fatigue, Sleeping disorder, O2/dyspnea, Nausea/emesis, Suffering; each item rated 0-10, total score 0-70) was used to screen for cancer-related symptoms and identify a treatment-specific target symptom for each enrolled patient. Accordingly, a personalized palliative care intervention was implemented based on the identified target. Efficacy of this strategy was then assessed by monitoring changes in the PERSONS score after approximately 10 days of treatment. Non-parametric statistical tests were employed to evaluate differences in symptom distributions between baseline and post-treatment scores: the Wilcoxon signed-rank test for comparisons between two groups and the Kruskal-Wallis test for comparisons across more than two groups. All analyses were conducted using R v4.1. Results: Among 72 prospectively enrolled patients, most had intermediate KPS scores (30-40, 47%; 50-60, 33%) and were not on active treatment (73%); PaP score was A, B and C in 27%, 61% and 11% of patients, respectively. The median PERSONS score at baseline was 26 (range 9 to 51). Pain was identified as the target symptom in 33 (47%) of patients, followed by dyspnea (14%), fatigue (11%), suffering (11%), nausea/emesis (7%) and cachexia (7%). When identified as a target symptom, suffering had numerically higher scores (range, 7-10; Kruskal-Wallis p = .14). PERSONS scores across non-target symptoms were numerically higher in patients with fatigue, pain and nausea/emesis identified as target symptoms. After a median of 9.5 days (range 6 to 138) of targeted treatment, PERSONS scores across non-target symptoms were significantly lower (p = 7.9e-05; median difference = -6, range = -24 to +10), as was intensity of target symptoms (p = 7.2e-14). Conclusions: Focusing on a targeted symptom through a short treatment course not only reduced that specific symptom but also demonstrated clinically significant improvements in non-target symptoms. This comprehensive approach, emphasizing the interconnectedness of symptoms, has the potential to optimize patient care and enhance clinical outcomes in the context of advanced cancer management.