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Patient-reported symptoms improve performance of risk prediction models for ED visits among patients with cancer: a population-wide study in Ontario using administrative data

Sutradhar R, Rostami M, Barbera L. J Pain Symptom Manage. 2019; Jul 16 [Epub ahead of print]. DOI: 10.1016/j.jpainsymman.2019.07.007.


Background — Prior work shows measurements of symptom severity using the Edmonton Symptom Assessment Scale (ESAS) are associated with ED visits in cancer patients, however it is not known if symptom severity improves the ability to predict ED visits.

Methods — This was a population-based study of patients who were diagnosed with cancer and had at least one ESAS assessment completed between 2007 and 2015 in Ontario, Canada. After splitting the cohort into training and test sets, 2 ED visit risk prediction models using logistic regression were developed on the training cohort, one without ESAS and one with ESAS. The predictive performance of each risk model was assessed on the test cohort and compared with respect to area under the curve and calibration.

Results — The full cohort consisted of 212,615 unique patients with a total of 1,267,294 ESAS assessments. The risk prediction model including ESAS was superior in sensitivity, specificity, accuracy, and discrimination. The area under the curve was 73.7% under the model with ESAS, whereas it was 70.1% under the model without ESAS. The model with ESAS was also better calibrated. This improvement in calibration was particularly noticeable among patients in the higher deciles of predicted risk.

Conclusion — This study demonstrates the importance of incorporating symptom measurements when developing an ED visit risk calculator for cancer patients. Improved predictive models for ED visits using measurements of symptom severity may serve as an important clinical tool to prompt timely interventions by the cancer care team before an ED visit is necessary.

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