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Palliative care outcomes in surgical oncology patients with advanced malignancies: a mixed methods approach

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Abstract

Purpose

To prospectively compare outcomes and processes of hospital-based early palliative care with standard care in surgical oncology patients (N = 152).

Methods

A randomized, mixed methods, longitudinal study evaluated the effectiveness of a hospital-based Pain and Palliative Care Service (PPCS). Interviews were conducted presurgically and at follow-up visits up to 1 year. Primary outcome measures included the Gracely Pain Intensity and Unpleasantness Scales and the Symptom Distress Scale. Qualitative interviews assessed social support, satisfaction with care, and communication with providers. Survival analysis methods explored factors related to treatment crossover and study discontinuation. Models for repeated measures within subjects over time explored treatment and covariate effects on patient-reported pain and symptom distress.

Results

None of the estimated differences achieved statistical significance; however, for those who remained on study for 12 months, the PPCS group performed better than their standard of care counterparts. Patients identified consistent communication, emotional support, and pain and symptom management as positive contributions delivered by the PPCS.

Conclusions

It is unclear whether lower pain perceptions despite greater symptom distress were clinically meaningful; however, when coupled with the patients’ perceptions of their increased resources and alternatives for pain control, one begins to see the value of an integrated PPCS.

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Abbreviations

PPCS:

Pain and Palliative Care Service

NIH:

Institutes of Health

CC:

Clinical Center

NCI:

National Cancer Institute

IRB:

Institutional Review Board

ICU:

Intensive Care Unit

APACHE II:

The Acute Physiology and Chronic Health Evaluation

GPS:

Gracely Pain Scales

SDS:

Symptom Distress Scale

CES-D:

Center for Epidemiologic Studies Depression Scale

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Author information

Authors and Affiliations

  1. National Institutes of Health Clinical Center, Building 10, Room 2B14, 10 Center Drive, Bethesda, MD, 20892, USA

    Gwenyth R. Wallen, Claiborne Miller-Davis & Nancy Ames

  2. Pain and Palliative Care Service, National Institutes of Health Clinical Center, 10 Center Drive, 2-1733 MSC 1517, Bethesda, MD, 20892, USA

    Karen Baker, Daniel Handel & Ann Berger

  3. United BioSource Corporation, 430 Bedford Street, Suite 300, Lexington, MA, 02420, USA

    Marilyn Stolar

  4. Shenandoah University, 348 Renaissance Drive, Martinsburg, WV, 25403, USA

    Jan Yates

  5. National Institutes of Health Clinical Center, 5207 Dorset Avenue, Chevy Chase, MD, 20815, USA

    Jacques Bolle

  6. Palliative Care Department, George Washington University Hospital, 900 23rd St NW, Washington, DC, 20037, USA

    Donna Pereira

  7. National Institutes of Health, National Cancer Institute, 6130 Executive Boulevard, Bethesda, MD, 20892, USA

    Diane St. Germain

Authors
  1. Gwenyth R. Wallen
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  2. Karen Baker
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Correspondence to Gwenyth R. Wallen.

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Wallen, G.R., Baker, K., Stolar, M. et al. Palliative care outcomes in surgical oncology patients with advanced malignancies: a mixed methods approach. Qual Life Res 21, 405–415 (2012). https://doi.org/10.1007/s11136-011-0065-7

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