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

Kurt Kroenke; Veronica Lam; Kathryn J Ruddy; Deirdre R Pachman; Jeph Herrin; Parvez A Rahman; Joan M Griffin; Andrea L Cheville

doi:10.1016/j.jpainsymman.2023.01.020

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

J Pain Symptom Manage. 2023 May;65(5):367-377. doi: 10.1016/j.jpainsymman.2023.01.020. Epub 2023 Feb 2.

Authors

Kurt Kroenke¹, Veronica Lam², Kathryn J Ruddy³, Deirdre R Pachman⁴, Jeph Herrin⁵, Parvez A Rahman⁶, Joan M Griffin⁷, Andrea L Cheville⁸

Affiliations

¹ Indiana University School of Medicine (K.K.), Indianapolis, Indiana, USA; Regenstrief Institute, Inc. (K.K.), Indianapolis, Indiana, USA. Electronic address: kkroenke@regenstrief.org.
² Department of Physical Medicine and Rehabilitation (V.L., A.L.C.), Mayo Clinic, Rochester, Minnesota, USA.
³ Division of Medical Oncology (K.J.R.), Mayo Clinic, Rochester, Minnesota, USA.
⁴ Division of Community Internal Medicine, Geriatrics, and Palliative Care (D.R.P.), Mayo Clinic, Rochester, Minnesota, USA.
⁵ Yale University School of Medicine (J.H.), New Haven, Connecticut, USA.
⁶ Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.A.R., J.M.G., A.L.C.), Mayo Clinic, Rochester, Minnesota, USA.
⁷ Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.A.R., J.M.G., A.L.C.), Mayo Clinic, Rochester, Minnesota, USA; Division of Health Care Delivery Research (J.M.G.), Mayo Clinic, Rochester, Minnesota, USA.
⁸ Department of Physical Medicine and Rehabilitation (V.L., A.L.C.), Mayo Clinic, Rochester, Minnesota, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.A.R., J.M.G., A.L.C.), Mayo Clinic, Rochester, Minnesota, USA.

Abstract

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 clinically relevant symptoms ranging from 45.2% for fatigue to 68.6% for depression. The summed SPPADE composite score demonstrated 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 clinical approaches that optimize detection and management.

Trial registration: ClinicalTrials.gov NCT03892967.

Keywords: Cancer; anxiety; depression; fatigue; pain; physical function; psychometrics; sleep.

Publication types

Pragmatic Clinical Trial
Randomized Controlled Trial
Research Support, N.I.H., Extramural

MeSH terms

Depression / diagnosis
Depression / epidemiology
Fatigue / complications
Fatigue / epidemiology
Humans
Neoplasms* / complications
Neoplasms* / epidemiology
Neoplasms* / therapy
Prevalence
Reproducibility of Results
Sleep Wake Disorders* / epidemiology

Associated data

ClinicalTrials.gov/NCT03892967

Grants and funding

UM1 CA233033/CA/NCI NIH HHS/United States