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Association of patient-reported outcomes with subsequent nonfatal self-injury after a new cancer diagnosis

Hallet J, Sutradhar R, Isenberg-Grzeda E, Noel CW, Mahar AL, Vigod SN, Bolton J, Deleemans J, Chan WC, Coburn NG, Eskander A; Enhanced Supportive Psycho-oncology Canadian Care (ESPOC) Group. JAMA Oncol. 2022; 8(5):e220203. Epub 2022 Mar 31. DOI: https://doi.org/10.1001/jamaoncol.2022.0203


Importance — Nonfatal self-injury (NFSI) is a patient-centered manifestation of severe distress occurring in 3 out of 1000 patients after cancer diagnosis. How to identify patients at risk for NFSI remains unknown.

Objective — To examine the associations between patient-reported outcome measures and subsequent NFSI in patients with cancer.

Design, Setting, and Participants — This population-based matched case-control study included adults with a new cancer diagnosis reporting an Edmonton Symptom Assessment System (ESAS) score within 36 months of diagnosis in Ontario, Canada, 2007 to 2019. Data analysis was performed January 2007 to December 2019.

Main Outcomes and Measures — Cases included patients with NFSI, and controls were patients without NFSI. Cases and controls were matched 1:4. Multivariable conditional logistic regression assessed the association between moderate to severe ESAS symptom scores and total ESAS (t-ESAS, range 0-90) score with NFSI in the subsequent 180 days.

Results — Of 408 858 patients reporting 1 or more ESAS assessments, 425 patients experienced NFSI and reported an ESAS score in the preceding 180 days. Of those, 406 cases were matched to 1624 control patients without an NFSI. Cases reported a higher proportion of moderate to severe symptoms and higher t-ESAS score than controls prior to the event. After adjustment, moderate to severe anxiety (odds ratio [OR], 1.61; 95% CI, 1.14-2.27), depression (OR, 1.66; 95% CI, 1.20-2.31), and shortness of breath (OR, 1.65; 95% CI, 1.18-2.31) and each 10-point increase in t-ESAS score (OR, 1.51; 95% CI, 1.40-1.63) were independently associated with higher odds of subsequent NFSI.

Conclusions and Relevance — In this case-control study, reporting moderate to severe anxiety, depression, and shortness of breath and an increasing t-ESAS score after cancer diagnosis were associated with higher odds of NFSI in the following 180 days. These data support the prospective use of routine ESAS screening as a means of identifying patients at higher risk for NFSI to improve supportive care.

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