Predictors of high symptom burden in gynecologic oncology outpatients: Who should be referred to outpatient palliative care?

Carolyn Lefkowits, Michael W. Rabow, Alexander E. Sherman, Tuyen K. Kiet, Rachel Ruskin, John K. Chan, Lee May Chen

Research output: Contribution to journalArticle

22 Scopus citations


Objective To characterize symptom prevalence in gynecologic oncology outpatients and identify predictors of high symptom burden. Methods We performed a retrospective analysis of a convenience sample of symptom surveys from gynecologic oncology patients at a single cancer center over a 20-month period. The survey was based on the Edmonton Symptom Assessment System (ESAS), and assessed pain, depression, anxiety, fatigue and well-being. Information on demographics, disease, treatment and history of chronic pain, depression or anxiety was abstracted from medical records. Data was analyzed with descriptive and t-test statistics. Results We analyzed 305 surveys from unique patients. Symptom prevalence (severity score > 0/10) ranged from 60.1% (pain) to 79.7% (fatigue). Prevalence of moderate to severe symptoms (score ≥ 4/10) ranged from 32% (pain) to 47% (fatigue). There were no differences in symptom burden by site or stage of cancer. Patients with no active disease (38%) were less symptomatic. There was a trend toward higher symptom burden in patients younger than 50 years. There was higher symptom burden in patients receiving cancer treatment or with a pre-existing history of pain, anxiety or depression. Patients who expressed an interest in being seen by a symptom management service also had higher symptom burden. Conclusions Gynecologic oncology outpatients have a high symptom burden regardless of stage and site of cancer. Patients who are young, on treatment or have a history of chronic pain, depression or anxiety have a higher symptom burden. Consideration should be given to targeting these patients for outpatient palliative care services.

Original languageEnglish (US)
Pages (from-to)698-702
Number of pages5
JournalGynecologic Oncology
Issue number3
StatePublished - Jan 1 2014
Externally publishedYes



  • Gynecologic cancer
  • Palliative care
  • Symptom assessment
  • Symptom burden
  • Symptom management

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology

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