Sex-specific variation in symptoms presentation: Experience of an outpatient clinic integrated model between radiotherapy and palliative care

BackgroundThe Gender differences in the clinical symptoms presentation (CSP) are known and already studied in many settings of medicine, such as Cardiology and Neurology. However, these differences have been studied less deeply in Oncology and Palliative Care. Our analysis focused on evluating how gender can affect the CSP in an integrated outpatient clinic between Radiotherapy and Palliative Care (RaP).MethodsThis is a monocentric, observational study carried out in the RaP integrated outpatient clinic in a Research Cancer Hospital (IRCCS, IRST - Meldola, Italy). Descriptive statistics were reported for each Edmonton Symptom Assessment System (ESAS) item, separately by gender. Additionally, a set of linear models were developed to predict ESAS items score. Multivariable linear model incorporated all other symptoms, clinical characteristics (e.g tumor location), and the sex variable to evaluate possible gender effects. All analyses were performed using R statistical software.Results212 patients were enrolled in the study between 2016 and 2020. Most of the symptoms showed significant gender differences. Specifically, the symptom "Pain� showed higer values in the male population (mean: M5.1 vs. F 4.4). Conversely, the symptom "Anxiety� showed higer values in the female population (mean. M 2.0 vs F 3.0). Finally, the "total symptom distress score� resulted in higer values in the female population (mean: M 23.0 vs F 25.4). Interestingly, the symptom "malaise� is the only that showed an almost perfect equity for all values (mean M1.9 vs F 2.0). The linear model aimed at assessing, ceteris paribus, report 0.9 additional points than females (p= 0.053). Conversely, keeping constant all other factors, females report 0.95 higer expression of anxiety (p=0.002).ConclusionsThe gender differences in the CSP and their distribution highligheted in our analysis are important in the new subfield of medicine called "Gender Medicine". Especially in palliative care, data relating to patients symptoms is necessary to reach the goal of the best supoportive care. Additional studeis will be necessary to improve our knowledge in this field.Legal entity responsible for the studyL. Tontini.FundingHas not received any funding.DisclosureAll authors have declared no conflicts of interest.