Prevalence, Severity, and Co-Occurrence of SPPADE Symptoms in 31,866 Patients With Cancer

Objectives. To examine the prevalence, severity, and co-occurrence of SPPADE symptoms as well as their association with cancer type and patient characteristics.Background. The SPPADE symptoms (sleep disturbance, pain, physical function impairment, anxiety, depression, and low energy /fatigue) are prevalent, co-occurring, and undertreated in oncology and other clinical populations.Methods. Baseline SPPADE symptom data were analyzed from the E2C2 study, a stepped wedge pragmatic, population-level, cluster randomized clinical trial designed to evaluate a guideline-informed symptom management model targeting the six SPPADE symptoms. Symptom prevalence and severity were measured with a 0-10 numeric rating (NRS) scale for each of the six symptoms. Prevalence of severe (NRS >= 7) and potential clinically relevant (NRS >= 5) symptoms as well as co-occurrence of clinical symptoms were determined. Distribution-based methods were used to estimate the minimally important difference (MID). Associations of cancer type and patient characteristics with a SPPADE composite score were analyzed. Results. A total of 31,886 patients were assessed for SPPADE symptoms prior to, during, or soon after an outpatient medical oncology encounter. The proportion of patients with a potential clinically relevant symptom ranged from 17.5% for depression to 33.4% for fatigue. Co-occurrence of symptoms was high, with the proportion of patients with three or more additional clini-cally relevant symptoms ranging from 45.2% for fatigue to 68.6% for depression. The summed SPPADE composite score dem-onstrated good internal reliability (Cronbach's alpha of 0.86), with preliminary MID estimates of 4.1-4.3. Symptom burden differed across several types of cancer but was generally similar across most sociodemographic characteristics.Conclusion. The high prevalence and co-occurrence of SPPADE symptoms in patients with all types of cancer warrants clini-cal approaches that optimize detection and management. J Pain Symptom Manage 2023;65:367-377. (c) 2023 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Automated summary

This study aims to investigate the prevalence, severity, and co-occurrence of SPPADE symptoms, as well as their association with cancer type and patient characteristics. The findings suggest that SPPADE symptoms are prevalent, severe, and commonly co-occur in oncology and other clinical populations. The study highlights the importance of optimizing detection and management of SPPADE symptoms in all types of cancer patients.