Background: We assessed whether the presence and severity of common cancer symptoms are associated with the health utility score (HUS) generated from the EQ-5D (EuroQol Research Foundation, Rotterdam, Netherlands) in patients with cancer and evaluated whether it is possible pragmatically to integrate routine hus and symptom evaluation in our cancer population. Methods: Adult outpatients at Princess Margaret Cancer Centre with any cancer were surveyed cross-sectionally using the Edmonton Symptom Assessment System (ESAS) and the EQ-5D-3L, and results were compared using Spearman correlation coefficients and regression analyses. Results: Of 764 patients analyzed, 27% had incurable disease. We observed mild-to-moderate correlations between each ESAS symptom score and the HUS (Spearman coefficients: −0.204 to −0.416; p < 0.0001 for each comparison), with the strongest associations being those for pain (R = −0.416), tiredness (R = −0.387), and depression (R =−0.354). Multivariable analyses identified pain and depression as highly associated (both p < 0.0001) and tiredness as associated (p = 0.03) with the HUS. The ability of the ESAS to predict the HUS was low, at 0.25. However, by mapping ESAS pain, anxiety, and depression scores to the corresponding EQ-5D questions, we could derive the HUS using partial ESAS data, with Spearman correlations of 0.83–0.91 in comparisons with direct EQ-5D measurement of the HUS. Conclusions: The HUS derived from the EQ-5D-3L is associated with all major cancer symptoms as captured by the ESAS. The ESAS scores alone could not predict EQ-5D scores with high accuracy. However, ESAS-derived questions assessing the same domains as the EQ-5D-3L questions could be mapped to their corresponding EQ-5D questions to generate the HUS, with high correlation to the directly measured HUS. That finding suggests a potential approach to integrating routine symptom and HUS evaluations after confirmatory studies.

Background: Recent trial data demonstrated improved outcomes with real-time patient reported outcome questionnaires (PROQ) symptom assessments using PRO-CTCAE. However, outside of a clinical trial setting, there is limited information on the factors that affect the completion of PROQ in routine practice. Methods: In outpatient oncology clinics of a comprehensive cancer center (2013-2016), patients completing a variety of toxicity and symptom tools including PRO CTCAE, pain/physical function, and sleep/fatigue PROQ tools, were also assessed for their willingness to complete such tools regularly. Results: Of 1792 cancer patients across all disease sites, the median age was 60 (range 18-97) years; 56% were female; 74% were Caucasian]; 58% (95% CI: 53-63) were willing to complete PROQs regularly, and 77% (71-83) perceived utility in the PROQs. Only 7% (2-13) reported that answering PROQs made the visit more difficult. However, patients were less willing to complete PRO-CTCAE-based toxicity PROQs [52% (48-58)] than other PROQs [60% (56-63) %; p < 0.001]. This difference in willingness remained significant at p < 0.001, even after adjusting for other factors associated with less willingness: non-Caucasians (p = 0.03); poor performance status/health utility score (p < 0.001); palliative treatment intent (p = 0.02); longer length of survey (p < 0.001); and disease site (prostate and genitourinary cancers were the least willing [42% (37-48)] to complete the questionnaires, while 62% (56-67, p < 0.001) breast cancer patients were most willing). Conclusions: Routine assessment using PROQs is associated with approximately 60% acceptability of patients. Though the common socio-demographic factors helped explain some of the variability in acceptability in addition to length of survey and site of cancer, additional research is necessary to determine the lower acceptability rates of PRO-CTCAE-based tools in routine clinical use. Patient educational tools designed with consideration of these factors may improve acceptability, which may allow improved implementation of PROQ into routine practice. Legal entity responsible for the study: Princess Margaret Cancer Centre. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

Background: Health utility scores (HUS), a form of health-related quality of life (HRQoL) assessments useful in economic analyses, such as the EuroQol (EQ-5D) were originally standardized to health state preferences in healthy individuals. To demonstrate clinical appropriateness in cancer patients, we assessed the association of common cancer symptoms with EQ-5D HUS. Methods: Adult cancer outpatients were surveyed cross-sectionally using the Edmonton Symptom Assessment System (ESAS), the EQ-5D-3L, and clinico-demographic variables. ESAS rated symptoms from 0-10. HUS were derived from the EQ-5D-3L (Canadian conversion). ESAS symptoms were correlated with HUS using Spearman correlation coefficients (R). Multivariable regression analyses identified independent variables associated with HUS. Results: Of 764 patients across multiple cancers, 27% were palliative at assessment. There were significant correlations between each ESAS symptom score and HUS (p < 0.0001 for each comparison; Spearman coefficients: 0.20 to 0.42); the highest were for pain (R = 0.42), fatigue (R = 0.39), and depression (R = 0.35). In multivariable analyses, pain and depression symptom scores remained highly associated with HUS (p < 0.0001 each), while fatigue was of borderline significance (p = 0.059). Despite correlations, prediction of HUS by global ESAS scores was poor, with the highest prediction ability at 0.25. Because ESAS and EQ5D shared common symptom questions (pain, depression/anxiety), we evaluated if we could map and replace these EQ5D questions with ESAS. Spearman correlation of pain symptoms by EQ5D and ESAS was 0.95, while for depression/anxiety, 0.90. Replacing both questions yielded a correlation of 0.83. Conclusions: HUS is associated with many cancer symptoms, including pain, fatigue, nausea, depression, anxiety, drowsiness, loss of appetite, and shortness of breath. EQ-5D-3L derived HUS have clinical utility. On exploratory analysis, we cannot replace accurately the EQ5D with ESAS, although we can replace two symptom questions within EQ5D with ESAS with high correlation. Legal entity responsible for the study: Princess Margaret Cancer Centre, UHN, Toronto, Canada Funding: Cancer Care Ontario Disclosure: All authors have declared no conflicts of interest.