Impact of a Palliative Care Consultation Team on Cancer-Related Symptoms in Advanced Cancer Patients Referred to an Outpatient Supportive Care Clinic

Abstract: Context: Patients with advanced cancer may develop severe physical and psychosocial symptoms. There are limited data on the impact of an outpatient palliative consultation (PC) team on cancer-related symptoms. Objectives: To study the impact of the PC on symptoms in patients with advanced cancer receiving outpatient palliative care. Methods: Four hundred six consecutive patients referred to a supportive care outpatient center (OPC) from January 2006 to June 2007 with complete Edmonton Symptom Assessment Scale (0–10 scale) at the initial and follow-up visits were reviewed. Patient characteristics, change of symptoms at follow-up visit, and response rate were analyzed. Using logistic regression models, the predictors of improvement of pain and fatigue were assessed. Results: Median age was 59 years; 53% were female. Median interval between visits was 15 days. Mean scores at baseline and follow-up visits were fatigue 6.8 and 5.3 (P <0.0001), pain 5.3 and 4.1 (P <0.0001), depression 3.2 and 2.5 (P <0.0001), anxiety 3.7 and 2.8 (P <0.0001), dyspnea 2.7 and 2.5 (P =0.05), sleep 5 and 4 (P <0.0001), and well-being 5.2 and 4.4 (P <0.0001). Dyspnea (odds ratio and P-value, 0.90, 0.03), nausea (0.92, 0.06), and depression (0.91, 0.04) were associated with improvement in fatigue; drowsiness (1.10, 0.04), and feeling of well-being (0.87, 0.02) were associated with improvement in pain. Conclusion: The initial consult by PC achieved significant symptom improvement in patients receiving treatment in the OPC. Further prospective studies are needed. [ABSTRACT FROM AUTHOR]