Patient-Reported Symptom Burden and Temporal Trends During the First 18 Months After Gynecologic Cancer Diagnosis: A Population-Based Study

Objectives: Our objectives were to evaluate symptom prevalence, severity, and temporal trends ≤ 18 months from gynecologic cancer (Gyn-Ca) diagnosis using the ESAS-r questionnaire and to identify predictors of elevated symptom burden. Methods: We performed a retrospective population-based study of newly diagnosed Gyn-Ca patients in Ontario, Canada, from January 2007 to March 2022 using linked provincial healthcare databases. Patients with ≥1 ESAS-r completed ≤18 months from diagnosis were included. Diagnosis groups were created using WHO ICD-O3 codes. ESAS-r data were linked to provincial healthcare databases using unique coded identifiers. Primary outcome was a severe score (≥7) on any symptom by month (30-day block) from diagnosis, and secondary outcome was a moderate–severe score (≥4). Multivariable logistic regression identified predictors of elevated scores, with p < 0.05 being significant. Results: A total of 35,559 of 59,175 diagnosed patients (59.5%) completed ≥1 ESAS-r, with 207,000 unique assessments. Moderate–severe (≥4) or severe (≥7) scores were most common for tiredness (62.6%, 33.5%) and poor wellbeing (60.2%, 28.5%). All scores improved over time, with anxiety ≥ 4 dropping from 48.1% at diagnosis to 24.2% at 18 months. Patients with uterine cancer had the lowest incidence of elevated scores. Older age, lower rates of material deprivation and increased time from diagnosis were protective against elevated scores. Higher stage and comorbidity were predictive of elevated scores across all symptoms. Patients with vulvar/vaginal and cervix cancers had the highest odds of elevated scores. Conclusions: Patients with newly diagnosed Gyn-Ca report significant symptom burden in the first 18 months after diagnosis. Stage, diagnosis, and level of comorbidity were predictive of elevated scores, whereas older age, material resources and time from diagnosis were protective.