Emory emergency medicine physician Tammie Quest, MD, is leading a research study to evaluate the prevalence and characteristics of common symptoms in cancer patients who present to the Grady Memorial Hospital emergency department. The goal of the Cancer Symptom Evaluation Study (CASES) is to improve the patients' quality of life by managing their symptoms and minimizing their symptom burden across their course of illness.
The study is funded by a $25,000 Emory Medical Care Foundation (EMCF) grant, and attempts to provide a valid measure of symptom assessment among cancer patients in Grady's emergency department.
"We are treating and measuring symptoms because we know that patients may or may not tell their oncologist or primary medical doctor about their symptoms," explains Dr. Quest. "Often the patient is concerned about chemotherapy or other cancer-directed treatment versus not feeling bad along the way. And since depression, fatigue, nausea and vomiting are often severe in these patients, routine assessment at any point of contact is in order. The emergency department can serve as one place to assess and begin to manage symptoms through either initiation of treatment or referral."
"We also want to link the symptom measure that we see in the emergency department with follow-up to see if we can, overtime, improve symptoms in patients," she adds.
Dr. Quest, principal investigator for CASES, is an assistant professor of emergency medicine at the Emory University School of Medicine and an emergency physician at Grady Hospital. She is using the Edmonton Symptom Assessment System (ESAS) as well as two other measures to assess nine symptoms common in cancer patients that include: pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, well-being and shortness of breath. On the ESAS, patients are asked to rate the severity of each symptom from zero to 10 ¬ zero meaning the symptom is absent and 10 meaning symptoms of the worst possible severity. This type of assessment will help physicians improve patients' quality of life by managing their symptoms and minimizing their symptom burden.
"The ESAS shows enormous potential for use in the emergency department because it is rapid, brief, and suitable for low-literacy populations," Dr. Quest says.
During this one-year study, self-reporting cancer patients are identified as potential study participants upon being admitted into the emergency department. They are then asked if they are suffering from pain, nausea, depression, tiredness, anxiety, drowsiness, poor well-being, loss of appetite and shortness of breath. The patients are followed for 30 days to determine three things: were their symptoms addressed while receiving treatment at Grady, what sort of medications and referrals they received, and did their symptoms improve or remain the same.
Dr. Quest eventually plans to use the data to develop a symptom intervention protocol that focuses on the highest symptom burden presented in the emergency department. She also plans to collaborate with the Georgia Cancer Center for Excellence at Grady to provide follow-up treatment for patients.
"Our ultimate goal is to improve the quality of life in patients by managing their symptoms and optimizing their well-being," Dr. Quest says. "The fact that a cancer patient comes into the emergency department and doctors recognize that he exhibits certain symptoms is a huge opportunity to get those symptoms addressed and ultimately optimize the patient's quality of life."
For more information, or to enroll a patient in the CASES study, call (404) 779-5900.