Validating self-report and proxy reports of the Dexamethasone Symptom Questionnaire -Chronic for the evaluation of longer-term corticosteroid toxicity
Validating self-report and proxy reports of the Dexamethasone Symptom Questionnaire -Chronic for the evaluation of longer-term corticosteroid toxicity
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DOI：
10.1007/s00520-015-2897-0
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发表时间：
2016-03-01
影响因子：
3.1
通讯作者：
King, Madeleine
中科院分区：
文献类型：
--
作者：
Agar, Meera;Koh, Eng-Siew;King, Madeleine
脑肿瘤、脑转移瘤或晚期癌症；用皮质类固醇治疗，副作用会加重症状。这些最好由患者评估，补充临床评估。我们评估了地塞米松慢性症状问卷 (DSQ-Chronic)、患者和护理人员版本的可行性和有效性。进行了一项纵向队列研究，在基线、2、4 和 8 周后收集临床医生评定的毒性、表现状态、地塞米松剂量和 DSQ-Chronic（患者和护理人员版本）。患者患有原发性恶性脑肿瘤、脑转移瘤或晚期癌症；卡诺夫斯基性能状况为千分之四日元，预测生存率为千分之一日元八周。分析包括问卷完成率、地塞米松引起的副作用的频率和严重程度、患者和护理人员评级之间的一致性、与临床医生评级毒性的比较以及与表现状态的相关性。 招募了 66 名患者（平均年龄 60 岁）及其护理人员。基线时，两人的问卷完成率超过 90%，但随着时间的推移，问卷完成率有所下降，护理人员在所有时间点的完成率都较高。患者和代理人之间的一致性为中等至中等，虽然代理人系统地高估了 DSQ 慢性总分的症状严重程度，但偏差小于 10 分。对于更客观的症状，患者和临床医生的一致性更高。当患者状况相对良好时，DSQ-Chronic 是可行的。随着完成 DSQ-Chronic 的能力下降，护理人员可以成为代理评估者。临床医生捕捉皮质类固醇的毒性，这对患者来说可能并不明显。 DSQ-Chronic、患者和护理人员版本是用于临床医生评估的有用工具。
In brain tumours, brain metastases or advanced cancer; treatment with corticosteroids, side effects can add to symptoms. These are best assessed by patients, complementing clinical assessment. We assessed the feasibility and validity of the Dexamethasone Symptom Questionnaire-Chronic (DSQ-Chronic), patient and caregiver versions.A longitudinal cohort study was conducted, collecting clinician-rated toxicity, performance status, dexamethasone dose and DSQ-Chronic (patient and caregiver versions) at baseline, then 2, 4 and 8 weeks later. Patients had a primary malignant brain tumour, brain metastases, or advanced cancer; Karnofsky Performance Status a parts per thousand yen40 and predicted survival a parts per thousand yen8 weeks. Analysis included questionnaire completion rates, frequency and severity of dexamethasone-attributable side effects, agreement between patient and caregiver ratings, comparison with clinician-rated toxicity and correlation with performance status.Sixty-six patients were recruited (mean age 60 years), with their caregivers. Completion of questionnaires was over 90 % for the dyad at baseline but dropped over time, with caregiver completion rates higher at all timepoints. Agreement between patients and proxies was fair to moderate, and while proxies systematically overestimated symptom severity on DSQ-chronic total scores, the bias was less than 10 points. Patient and clinician agreement was higher for more objective symptoms.The DSQ-Chronic is feasible when the patient is relatively well. As capacity to complete the DSQ-Chronic diminishes, caregivers can be proxy-raters. Clinicians capture corticosteroid toxicities, which may not be obvious to the patient. The DSQ-Chronic, patient and caregiver versions, are useful tools to be used with clinician assessment.