Emergency department visits and unplanned hospitalizations (ED/Hosp) among patients with head and neck cancer (HNC) were associated with Edmonton Symptom Assessment System (ESAS) scores. These findings, from a population-based study, were published in the Journal of Clinical Oncology.

Patients with head and neck cancer experience some of the highest rates of symptom burden compared with other cancer sites. Uncontrolled symptoms often lead to high rates of ED/Hosp in this population. The ESAS uses patient-reported outcomes (PROs) to standardize symptom assessment; however, provincial data from Ontario, Canada, indicates these assessment scores are not always acted on. Therefore, this study was conducted to determine the association between ESAS scores and subsequent 14-day risk of ED/Hosp in patients with HNC to enhance the use of PRO information and encourage proactive management of these patients’ symptoms.

Administrative data from 11,761 patients with HNC treated at 7 centers in Ontario between 2007 and 2018 were analyzed for this study. Patients were assessed for ED/Hosp within 14 days of ESAS assessment. Participants were mostly men (75.4%), primarily aged 60 to 69 years (32.4%), and had many comorbidities (17.3% had more than 4 comorbidities)

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A total of 73,282 ESAS assessments were administered. There were 4054 ED visits and 1149 unplanned hospitalizations, totaling 5203 ED/Hosp events among 3170 patients.

ED/Hosp were associated with ESAS symptom scores for pain, tiredness, drowsiness, lack of appetite, shortness of breath, well-being, and depression (all P <.01). The strongest association was with pain scores (odds ratio [OR], 1.09; 95% CI, 1.08-1.11) and depression was the only symptom inversely associated with ED/Hosp (OR, 0.97; 95% CI, 0.95-0.99).

Patients with maximum ESAS scores had more ED/Hosp events (15.1%) compared with patients with minimum scores (1.5%). Likelihood of ED/Hosp increased by 23% for every 1-unit increase in ESAS (OR, 1.23; 95% CI, 1.22-1.25).

This study may have been limited by the ESAS assessment, which is not specific to HNC, and no causal relationships were found between features of the ESAS and hospitalizations.

The study authors concluded there was a dose-response relationship between ESAS symptom scores and ED/Hosp, making it a potentially useful tool for stratifying patients with HNC at high risk for unplanned hospitalizations.

Disclosure: Multiple authors declared affiliation with or received funding from the pharmaceutical industry. Please refer to the original article for a full list of disclosures.


Noel CW, Sutradhar R, Zhao H, et al. Patient-reported symptom burden as a predictor of emergency department use and unplanned hospitalization in head and neck cancer: a longitudinal population-based study. J Clin Oncol. Published online January 6, 2021. doi:10.1200/JCO.20.01845