{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T08:42:34Z","timestamp":1778575354075,"version":"3.51.4"},"reference-count":41,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Otolaryngol Head Neck Surg"],"published-print":{"date-parts":[[2025,10,1]]},"abstract":"<jats:sec id=\"ab-ooi250053-4\"><jats:title>Importance<\/jats:title><jats:p>Head and neck cancer (HNC) and its associated treatments are associated with substantial functional, psychological, and financial consequences. Patient-reported outcome measures (PROMs) play a crucial role in capturing the full impact of disease. Understanding how PROMs are associated with health care costs is critical for cancer care planning; however, the association of health care expenditure and PROMs is yet to be clarified.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi250053-5\"><jats:title>Objective<\/jats:title><jats:p>To assess the association between Edmonton Symptom Assessment System (ESAS) scores and direct health care costs incurred in 30 days for adult patients with HNC.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi250053-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This cohort study used linked administrative datasets from Ontario, Canada, of adult patients who received a diagnosis of HNC between January 1, 2007, and December 31, 2022. Included patients had at least 1 ESAS assessment completed from the date of diagnosis to the date of death or January 31, 2023. Coprimary exposures were the highest individual symptom score (h-ESAS, from 0 to 10) and the sum total of the individual scores of the 9 symptoms (t-ESAS, from 0-90). Multivariable negative binomial regression models using a generalized estimating equation approach under an exchangeable correlation structure were used to assess the association between each primary exposure and 30-day costs, accounting for patient age, sex, immigration status, socioeconomic status, cancer type, and recent cancer-directed treatment modality, updated to each ESAS assessment date. Data analysis was performed from September 2024 to February 2025.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi250053-7\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>A 30-day cost-capturing window was defined around each ESAS assessment date to comprise a 7-day interval before this date and a 22-day interval after this date. Direct health care costs incurred during this 30-day window were estimated using a patient-level case-costing algorithm adjusted to 2023 Canadian dollars.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi250053-8\"><jats:title>Results<\/jats:title><jats:p>The total sample population was 16\u202f544 adult patients with HNC (mean [SD] age at diagnosis, 63.7 [11.5] y; 12 526 [75.7%] male individuals ) and their 90\u202f025 ESAS assessments completed since the date of diagnosis. Each 1-point increase in h-ESAS was associated with a 22% increase in 30-day costs (rate ratio [RR], 1.22; 95% CI, 1.21-1.22). Likewise, relative costs increased progressively with higher t-ESAS scores, peaking among patients with scores of 71 to 80 (RR, 4.82; 95% CI, 4.32-5.39).<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi250053-9\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>This cohort study found that both h-ESAS and t-ESAS were significantly associated with 30-day costs. These findings highlight the potential role of PROMs in cost-mitigation strategies for HNC care.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamaoto.2025.2641","type":"journal-article","created":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T15:31:38Z","timestamp":1756999898000},"page":"976","source":"Crossref","is-referenced-by-count":3,"title":["Patient-Reported Symptoms and Direct Health Care Costs in Head and Neck Cancer"],"prefix":"10.1001","volume":"151","author":[{"given":"Kennedy","family":"Ayoo","sequence":"first","affiliation":[{"name":"Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada"},{"name":"Department of Vascular Surgery, University of Toronto, Toronto, Ontario, Canada"},{"name":"Sunnybrook Research Institute, Sunnybrook Health Sciences Centre & University of Toronto, Toronto, Ontario, Canada"},{"name":"ICES, Toronto, Ontario, Canada"},{"name":"Department of Surgery, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rinku","family":"Sutradhar","sequence":"additional","affiliation":[{"name":"Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada"},{"name":"Sunnybrook Research Institute, Sunnybrook Health Sciences Centre & University of Toronto, Toronto, Ontario, Canada"},{"name":"ICES, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qing","family":"Li","sequence":"additional","affiliation":[{"name":"Sunnybrook Research Institute, Sunnybrook Health Sciences Centre & University of Toronto, Toronto, Ontario, Canada"},{"name":"ICES, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"No\u00e9mie","family":"Villemure-Poliquin","sequence":"additional","affiliation":[{"name":"Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada"},{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada"},{"name":"Sunnybrook Research Institute, Sunnybrook Health Sciences Centre & University of Toronto, Toronto, Ontario, Canada"},{"name":"ICES, Toronto, Ontario, Canada"},{"name":"Department of Surgery, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rui","family":"Fu","sequence":"additional","affiliation":[{"name":"Departments of Community Health Sciences, Surgery & Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada"},{"name":"Sunnybrook Research Institute, Sunnybrook Health Sciences Centre & University of Toronto, Toronto, Ontario, Canada"},{"name":"ICES, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelvin K. 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