Supportive Care in Cancer

, Volume 21, Issue 11, pp 3031–3037 | Cite as

Palliative and oncologic co-management: symptom management for outpatients with cancer

  • Kara Bischoff
  • Vivian Weinberg
  • Michael W. Rabow
Original Article

Abstract

Purpose

Although outpatient palliative care clinics are increasingly common, evidence for their efficacy remains limited.

Methods

We conducted an observational study at the palliative care clinic of an academic cancer center to assess the association between palliative care co-management and symptoms and quality of life. Two hundred sixty-six adult outpatients were seen for a minimum of two palliative care visits within 120 days. A subset of 142 patients was seen for a third visit within 240 days. Patients completed a questionnaire containing validated symptom, quality of life, and spiritual wellbeing questions at each visit.

Results

The first follow-up visit was on average 41 days after the initial visit; the second follow-up visit was on average 81 days after the initial visit. Between the initial and first follow-up visits, there was significant improvement in pain (p < 0.001), fatigue (p < 0.001), depression (p < 0.001), anxiety (p < 0.001), quality of life (p = 0.002), and spiritual wellbeing (p < 0.001), but not nausea (p = 0.14). For the subset of patients seen for a second follow-up visit, the improvements in pain, fatigue, depression, anxiety, quality of life, and spiritual wellbeing persisted (p ≤ 0.005 for trend of each symptom). Patients had similar improvement regardless of their gender, age, ethnicity, disease stage, disease progression, and concurrent oncologic treatments.

Conclusions

Palliative care was associated with significant improvement in nearly all the symptoms evaluated. A sustained change in symptoms was observed in the subset of patients seen for a second follow-up visit. Members of all subgroups improved.

Keywords

Palliative care Symptom management Cancer Outpatient Ambulatory care 

Notes

Acknowledgments

The authors were funded by the University of California at San Francisco, which had no role in the design, conduct, analysis, or publishing of this study.

Conflict of interest

The authors have no conflicts of interest to report.

References

  1. 1.
    Walsh D, Donnelly S, Rybicki L (2000) The symptoms of advanced cancer: relationship to age, gender, and performance status in 1,000 patients. Support Care Cancer 8(3):175–9PubMedCrossRefGoogle Scholar
  2. 2.
    Vainio A, Auvinen A (1996) Prevalence of symptoms among patients with advanced cancer: an international collaborative study. Symptom Prevalence Group. J Pain Symptom Manage 12(1):3–10PubMedCrossRefGoogle Scholar
  3. 3.
    Stromgren AS, Sjogren P, Goldschmidt D, Petersen MA, Pedersen L, Groenvold M (2006) Symptom priority and course of symptomatology in specialized palliative care. J Pain Symptom Manage 31(3):199–206PubMedCrossRefGoogle Scholar
  4. 4.
    Paice JA (2004) Assessment of symptom clusters in people with cancer. J Natl Cancer Inst Monogr 32:98–102PubMedCrossRefGoogle Scholar
  5. 5.
    Teunissen SC, Wesker W, Kruitwagen C, de Haes HC, Voest EE, de Graeff A (2007) Symptom prevalence in patients with incurable cancer: a systematic review. J Pain Symptom Manage 34(1):94–104PubMedCrossRefGoogle Scholar
  6. 6.
    Lidstone V, Butters E, Seed PT, Sinnott C, Beynon T, Richards M (2003) Symptoms and concerns amongst cancer outpatients: identifying the need for specialist palliative care. Palliat Med 17(7):588–95PubMedCrossRefGoogle Scholar
  7. 7.
    Whitmer KM, Pruemer JM, Nahleh ZA, Jazieh AR (2006) Symptom management needs of oncology outpatients. J Palliat Med 9(3):628–30PubMedCrossRefGoogle Scholar
  8. 8.
    Curtis EB, Krech R, Walsh TD (1991) Common symptoms in patients with advanced cancer. J Palliat Care 7(2):25–9PubMedGoogle Scholar
  9. 9.
    Foley K, Gelband H (2001) Improving palliative care for cancer. National Academies, Washington, D.CGoogle Scholar
  10. 10.
    Smith TJ, Temin S, Alesi ER, Abernethy AP, Balboni TA, Basch EM et al (2012) American society of clinical oncology provisional clinical opinion: the integration of palliative care into standard oncology care. J of Clinical Oncol: Official J of the Am Soc of Clinical Oncol 30(8):880–7Google Scholar
  11. 11.
    Hui D, Elsayem A, De la Cruz M, Berger A, Zhukovsky DS, Palla S et al (2010) Availability and integration of palliative care at US cancer centers. JAMA 303(11):1054–61PubMedCrossRefGoogle Scholar
  12. 12.
    Yennurajalingam S, Urbauer DL, Casper KL, Reyes-Gibby CC, Chacko R, Poulter V et al (2011) Impact of a palliative care consultation team on cancer-related symptoms in advanced cancer patients referred to an outpatient supportive care clinic. J Pain Symptom Manage 41(1):49–56CrossRefGoogle Scholar
  13. 13.
    Strasser F, Sweeney C, Willey J, Benisch-Tolley S, Palmer JL, Bruera E (2004) Impact of a half-day multidisciplinary symptom control and palliative care outpatient clinic in a comprehensive cancer center on recommendations, symptom intensity, and patient satisfaction: a retrospective descriptive study. J Pain Symptom Manage 27(6):481–91PubMedCrossRefGoogle Scholar
  14. 14.
    Follwell M, Burman D, Le LW, Wakimoto K, Seccareccia D, Bryson J et al (2009) Phase II study of an outpatient palliative care intervention in patients with metastatic cancer. J Clin Oncol 27(2):206–13PubMedCrossRefGoogle Scholar
  15. 15.
    Bruera E, Michaud M, Vigano A, Neumann CM, Watanabe S, Hanson J (2001) Multidisciplinary symptom control clinic in a cancer center: a retrospective study. Support Care Cancer 9(3):162–8PubMedCrossRefGoogle Scholar
  16. 16.
    Yennurajalingam S, Atkinson B, Masterson J, Hui D, Urbauer D, Tu SM et al (2012) The impact of an outpatient palliative care consultation on symptom burden in advanced prostate cancer patients. Journal of Palliative Medicine 15(1):20–4PubMedCrossRefGoogle Scholar
  17. 17.
    Bakitas M, Lyons KD, Hegel MT, Balan S, Brokaw FC, Seville J et al (2009) Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the Project ENABLE II randomized controlled trial. JAMA 302(7):741–9PubMedCrossRefGoogle Scholar
  18. 18.
    Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA et al (2010) Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 363(8):733–42PubMedCrossRefGoogle Scholar
  19. 19.
    Kim Y, Yen IH (2012) Rabow MW. Comparing symptom burden in patients with metastatic and nonmetastatic cancer, Journal of Palliative Medicine. doi: 10.1089/jpm.2011.0456 Google Scholar
  20. 20.
    Nekolaichuk C, Watanabe S, Beaumont C (2008) The Edmonton Symptom Assessment System: a 15-year retrospective review of validation studies (1991–2006). Palliat Med 22(2):111–22PubMedCrossRefGoogle Scholar
  21. 21.
    Steinhauser KE, Clipp EC, Bosworth HB, McNeilly M, Christakis NA, Voils CI et al (2004) Measuring quality of life at the end of life: validation of the QUAL-E. Palliat Support Care 2(1):3–14PubMedCrossRefGoogle Scholar
  22. 22.
    Steinhauser KE, Voils CI, Clipp EC, Bosworth HB, Christakis NA, Tulsky JA (2006) “Are you at peace?”: one item to probe spiritual concerns at the end of life. Arch Intern Med 166(1):101–5PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Kara Bischoff
    • 1
  • Vivian Weinberg
    • 2
  • Michael W. Rabow
    • 3
  1. 1.Department of MedicineUniversity of California, San FranciscoSan FranciscoUSA
  2. 2.Helen Diller Family Comprehensive Cancer Center, Biostatistics CoreUniversity of California, San FranciscoSan FranciscoUSA
  3. 3.Division of General Internal Medicine, Department of MedicineUniversity of California, San FranciscoSan FranciscoUSA

Personalised recommendations