Published online Jul 24, 2022. doi: 10.5306/wjco.v13.i7.577
Peer-review started: January 29, 2022
First decision: May 12, 2022
Revised: June 5, 2022
Accepted: June 21, 2022
Article in press: June 21, 2022
Published online: July 24, 2022
Adjuvant chemotherapy (AC) represents a fundamental part of multidisciplinary treatment of women with high-risk breast cancer, since it has been associated to a reduced risk of developing cancer recurrence, as well as to an increased survival. However, no standardised guidelines that regulate the pre-treatment assessment of patients candidates for AC exist. In common practice, a pre-chemotherapy medical visit before every cycle of AC is scheduled, and this represents a time- and resource-demanding practice.
Accurate use of the Edmonton Symptom Assessment Scale (ESAS) may lead to identify patients who do not need to visit a doctor during each course of AC.
To evaluate the value of the ESAS in safely reduce the number of medical visits prior adjuvant chemotherapy.
One-hundred breast cancer women candidates to AC were administered the ESAS score (ESAS Group), and were scheduled to receive a total of three medical visits for the entire AC duration. They were prospectively compared to a to a matched-pair group of 100 patients who received adjuvant chemotherapy without ESAS (no-ESAS Group) and were scheduled to receive 16 medical visits for the entire AC duration. Study endpoints were the number of medical visits, occurrence of severe complications, and the number of unplanned visits.
The mean number of medical visits was 4.38 ± 0.51 in the ESAS Group and 16.18 ± 1.82 in the no-ESAS group (P < 0.001). Unplanned visits during the entire duration of chemotherapy were 8 in the ESAS Group and 18 in the no-ESAS Group visits (P = 0.035). Grade 3-4 toxicity did not differ between the study groups (P = 0.652). Forty-eight patients of the ESAS Group received additional visits due to an ESAS score > 3. With multivariate analysis, women of the ESAS group were more likely to undergo additional visits for an ESAS score > 3 if they were aged 60 or older, received a mastectomy, or had tumour stage II/III.
Our results suggest that the ESAS score may be used for selecting a group of breast cancer patients for whom it is safe to reduce the number of medical visits in the setting of AC. This may permit a more rational utilization of human resources and a possible reduction of coronavirus pandemic 2019 infection risk in oncologic patients.
Additional studies are needed to gain new insights into the role of patient-reported outcome strategies in the management of AC in the setting of breast cancer.