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Impact of outpatient palliative care (PC) on symptom burden in patients with advanced cancer at a tertiary cancer center in Jordan

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Abstract

Purpose

Outpatient palliative care clinics are essential for early symptom management in patients with advanced cancer. Few outpatient programs are available in the Middle East. In this prospective study, we examined the symptom changes among cancer patients seen at a palliative care clinic in Jordan.

Methods

Patients with advanced cancer who had an outpatient palliative care consultation and not delirious were enrolled. The Edmonton Symptom Assessment System (ESAS), Karnofsky Performance Scale (KPS), and Memorial Delirium Assessment Scale (MDAS) were collected at consultation and follow up visit 14–34 days later. We compared symptom changes using paired t test.

Results

Among the 182 enrolled patients, the average age was 53 years, 47 % were females, and 95 % had stage IV cancer. The median duration between the two clinic visits was 21 days (interquartile range 15–28). KPS decreased between visits (mean 68 vs. 66 %, P = 0.004). ESAS pain (5.9 vs. 5.1, P = 0.004) and sleep (4.6 vs. 4.1, P = 0.007) improved significantly over time. The remaining ESAS symptoms decreased in intensity, albeit not statistically significant. Among patients who presented with moderate to severe symptom intensity, pain (7 vs. 6, P < 0.0001), fatigue (7 vs. 6, P = 0.003), nausea (7 vs. 4, P < 0.0001), depression (7 vs. 5, P = 0.0008), anxiety (7 vs. 5, P < 0.0001), drowsiness (6 vs. 5, P < 0.001), appetite (7 vs. 6, P = 0.0007), well-being (7 vs. 6, P < 0.0001), dyspnea (6 vs. 5, P = 0.0006), and sleep (7 vs. 5, P < 0.0001) all improved significantly.

Conclusions

Our outpatient palliative care consultation was associated with improvement in ESAS, particularly for patients who presented with moderate to severe symptoms. Further studies are needed to examine predictors of symptom response, longer term outcomes, and how to improve access to outpatient palliative care in the Middle East.

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Authors and Affiliations

  1. Department of Palliative Care, King Hussein Cancer Center, 202 Queen Rania Al Abdullah St., P.O.Box 1269, Al-Jubeiha, Amman, 11941, Jordan

    Omar Shamieh, Odai Khamash, Mustafa Khraisat, Omar Jbouri, Mohammad Awni, Abdulrahman Al-Hawamdeh, Ghadeer Arja, Sawsan Ajarmeh & Dalia Al-Rimawi

  2. Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center , 1515 Holcombe Boulevard, Unit 1414, Houston, TX, 77030, USA

    David Hui

Authors
  1. Omar Shamieh
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  2. Odai Khamash
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Correspondence to Omar Shamieh.

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The authors declare that they have no conflict of interest.

Funding

This research was supported by intermural grant from King Hussein Cancer Center.

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Shamieh, O., Khamash, O., Khraisat, M. et al. Impact of outpatient palliative care (PC) on symptom burden in patients with advanced cancer at a tertiary cancer center in Jordan. Support Care Cancer 25, 177–183 (2017). https://doi.org/10.1007/s00520-016-3395-8

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  • DOI: https://doi.org/10.1007/s00520-016-3395-8

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