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Health and Quality of Life Outcomes
Gynecologic oncology patients' satisfaction and symptom severity
during palliative chemotherapy
Vivian E von Gruenigen*1,2, Jessica R Hutchins1, Anne Marie Reidy1,
Heidi E Gibbons1, Barbara J Daly1,2, Elisa M Eldermire1 and Nancy L Fusco1
Address: 1University Hospitals Case Medical Center, Cleveland, Ohio 44106, USA and 2Case Western Reserve University, 11100 Euclid Avenue,
Cleveland, Ohio 44106, USA
Email: Vivian E von Gruenigen* - firstname.lastname@example.org; Jessica R Hutchins - email@example.com;
Anne Marie Reidy - firstname.lastname@example.org; Heidi E Gibbons - email@example.com; Barbara J Daly - firstname.lastname@example.org;
Elisa M Eldermire - email@example.com; Nancy L Fusco - firstname.lastname@example.org
* Corresponding author
Background: Research on quality and satisfaction with care during palliative chemotherapy in oncology
patients has been limited. The objective was to assess the association between patient's satisfaction with
care and symptom severity and to evaluate test-retest of a satisfaction survey in this study population.
Methods: A prospective cohort of patients with recurrent gynecologic malignancies receiving
chemotherapy were enrolled after a diagnosis of recurrent cancer. Patients completed the Quality of End-
of-Life care and satisfaction with treatment scale (QUEST) once upon enrollment in an outpatient setting
and again a week later. Patients also completed the Mini-Mental Status Exam, the Hospital Anxiety/
Depression Scale, a symptom severity scale and a demographic survey. Student's t-test, correlation
statistics and percent agreement were used for analysis.
Results: Data from 39 patients were analyzed. Mean (SD) quality of care summary score was 41.95 (2.75)
for physicians and 42.23 (5.42) for nurses (maximum score was 45; p = 0.76 for difference in score
between providers). Mean (SD) satisfaction of care summary score was 29.03 (1.92) for physicians and
29.28 (1.70) for nurses (maximum score was 30; p = 0.49 for difference between providers). Test-retest
for 33 patients who completed both QUEST surveys had high percent agreement (74–100%), with the
exception of the question regarding the provider arriving late (45 and 53%). There was no correlation
between quality and satisfaction of care and symptom severity. Weakness was the most common symptom
reported. Symptom severity correlated with depression (r = 0.577 p < 0.01). There was a trend towards
a larger proportion of patients reporting pain who had three or more prior chemotherapy regimens (p =
0.075). Prior number of chemotherapy regimens or time since diagnosis was not correlated with symptom
severity score. Anxiety and depression were correlated with each other (r = 0.711, p < 0.01). There was
no difference in symptom severity score at enrollment between those patients who have since died (n =
19) versus those who are still alive.
Conclusion: The QUEST Survey has test-retest reliability when used as a written instrument in an
outpatient setting. However, there was no correlation between this measure and symptom severity.
Patient evaluation of care may be more closely related to the interpersonal aspects of the health care
provider relationship than it is to physical symptoms.
Published: 30 October 2006
Health and Quality of Life Outcomes 2006, 4:84doi:10.1186/1477-7525-4-84
Received: 07 August 2006
Accepted: 30 October 2006
This article is available from: http://www.hqlo.com/content/4/1/84
© 2006 von Gruenigen et al; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0),
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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lyzed the data. VVG, HG and BD drafted the manuscript;
AMR, JH, BD, EE and NF provided critical review. All
authors read and approved the final manuscript.
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Shortness of Breath