The PERSONS score for symptoms assessment in simultaneous care setting: A pilot study

One of the first steps to early integrate palliative care into oncology practice is a timely and efficient evaluation of symptoms (Bakitas et al., 2015; Davis et al., 2015; Temel et al., 2010). In a recent position paper, the Italian Association of Medical Oncology tells oncologists that they “must be able to prevent, recognize, measure, and treat all cancer-related symptoms” (Zagonel et al., 2017). Major international scientific societies such as the American Society of Clinical Oncology and the European Society of Medical Oncology have often defined the key role of symptoms evaluation and management to force the integration of palliative care into oncology (Davis et al., 2015; Ferrel et al., 2017). Nevertheless, a recent survey conducted by the Italian Association of Medical Oncology shows that only 20% of oncologists regularly uses valid tools to evaluate symptoms, 45% exclusively use them in the context of clinical trials, 30% use them only occasionally, and 5% never use them (Zagonel et al., 2016). These data confirm what we and other authors have previously published (Giusti et al., 2017; Porzio et al., 2005a); we could say that, notwithstanding the effort that scientific societies put forth to promote early palliative care, few changes have been observed in terms of oncologists attitude toward a systematic evaluation of symptoms. That oncologists are mainly focused on disease-oriented therapies and that there is a lack of time in routine practice to evaluate symptoms may explain why there are still barriers in providing palliative care at an early time point. Some experiences reported that in an ambulatory oncology setting the average time spent to visit a patient during a chemotherapy session is 15 minutes (Grávalos et al., 2012; Greer et al., 2013). Thus, there is a need of simple and quick tools that enable a timely and efficient evaluation of symptoms. Recently, a newly designed questionnaire assesses seven items: pain, eating (loss of appetite/weight loss), rehabilitation (physical impairment), social situation (possibility for home care), suffering (anxiety/burden of disease/depression), O2 (dyspnea), and nausea/emesis (PERS2ON) has shown to be feasible for symptom assessment in a palliative care setting (Masel et al., 2016). PERS2ON works on a scale ranging from 0 (absence) to 10 (worst imaginable), resulting in a score ranging from 0 to 70. Given the characteristics of PERS2ON as a user-friendly and fast tool, we tested its applicability in a simultaneous care context with patients on active treatment. The objective of our study was to evaluate the feasibility of a modified pain, eating (loss of appetite), rehabilitation (asthenia), sleep (sleep disorders), O(2) (dyspnea, cough), nausea/vomiting, and suffering (anxiety/depression) (PERSONS) score, changing just one item and replacing social situation with sleep because this seemed to be more feasible in the outpatient care setting.