TY - JOUR
T1 - Characteristics of Unscheduled and Scheduled Outpatient Palliative Care Clinic Patients at a Comprehensive Cancer Center
AU - Azhar, Ahsan
AU - Wong, Angelique N
AU - Cerana, Agustina A.
AU - Balankari, Vishidha R.
AU - Adabala, Madhuri
AU - Liu, Diane D.
AU - Williams, Janet L.
AU - Bruera, Eduardo
N1 - Funding Information:
This work was supported in part by the National Institutes of Health (Cancer Center Support Grant CA016672; Biostatistics Resource Group). This study was presented in part at the American Society of Clinical Oncology Palliative Care in Oncology Symposium, September 2016. Ms. Melissa G. Burkett from the Department of Scientific Publications provided editorial assistance/recommendations. Dr. Bruera has received research funding grant from Helsinn Pharmaceuticals. The authors declare no conflicts of interest.
Funding Information:
This work was supported in part by the National Institutes of Health (Cancer Center Support Grant CA016672 ; Biostatistics Resource Group). This study was presented in part at the American Society of Clinical Oncology Palliative Care in Oncology Symposium, September 2016. Ms. Melissa G. Burkett from the Department of Scientific Publications provided editorial assistance/recommendations. Dr. Bruera has received research funding grant from Helsinn Pharmaceuticals. The authors declare no conflicts of interest.
Publisher Copyright:
© 2018 American Academy of Hospice and Palliative Medicine
PY - 2018/5
Y1 - 2018/5
N2 - Context: There is limited literature regarding outpatient palliative care and factors associated with unscheduled clinic visits. Objectives: To compare characteristics of patients with unscheduled vs. scheduled outpatient palliative care clinic visits. Methods: Medical records of 183 unscheduled cancer new outpatients and 104 unscheduled follow-up (FU) patients were compared with random samples of 361 and 314 scheduled new patients and FU patients, respectively. We gathered data on demographics, symptoms, daily opioid usage, and performance status. Results: Compared with scheduled new patients, unscheduled new patients had worse Edmonton Symptom Assessment Scale subscores for pain (P < 0.001), fatigue (P = 0.002), nausea (P = 0.016), depression (P = 0.003), anxiety (P = 0.038), drowsiness (P = 0.002), sleep (P < 0.001), and overall feeling of well-being (P = 0.001); had a higher morphine equivalent daily dose of opioids (median of 45 mg for unscheduled vs. 30 mg for scheduled; P < 0.001); and were more likely to be from outside the greater Houston area (P < 0.001). Most unscheduled and scheduled new and FU visits were for uncontrolled physical symptoms. Unscheduled FU patients, compared with scheduled FU patients, had worse Edmonton Symptom Assessment Scale subscores for pain (P < 0.001), fatigue (P < 0.001), depression (P = 0.002), anxiety (P = 0.004), drowsiness (P = 0.010), appetite (P = 0.023), sleep (P = 0.022), overall feeling of well-being (P < 0.001), and higher morphine equivalent daily dose of opioid (median of 58 mg for unscheduled FU visits vs. 40 mg for scheduled FU visits; P = 0.054). Conclusion: Unscheduled new FU patients have higher levels of physical and psychosocial distress and higher opioid intake. Outpatient palliative care centers should consider providing opportunities for walk-in visits for timely management and close monitoring of such patients.
AB - Context: There is limited literature regarding outpatient palliative care and factors associated with unscheduled clinic visits. Objectives: To compare characteristics of patients with unscheduled vs. scheduled outpatient palliative care clinic visits. Methods: Medical records of 183 unscheduled cancer new outpatients and 104 unscheduled follow-up (FU) patients were compared with random samples of 361 and 314 scheduled new patients and FU patients, respectively. We gathered data on demographics, symptoms, daily opioid usage, and performance status. Results: Compared with scheduled new patients, unscheduled new patients had worse Edmonton Symptom Assessment Scale subscores for pain (P < 0.001), fatigue (P = 0.002), nausea (P = 0.016), depression (P = 0.003), anxiety (P = 0.038), drowsiness (P = 0.002), sleep (P < 0.001), and overall feeling of well-being (P = 0.001); had a higher morphine equivalent daily dose of opioids (median of 45 mg for unscheduled vs. 30 mg for scheduled; P < 0.001); and were more likely to be from outside the greater Houston area (P < 0.001). Most unscheduled and scheduled new and FU visits were for uncontrolled physical symptoms. Unscheduled FU patients, compared with scheduled FU patients, had worse Edmonton Symptom Assessment Scale subscores for pain (P < 0.001), fatigue (P < 0.001), depression (P = 0.002), anxiety (P = 0.004), drowsiness (P = 0.010), appetite (P = 0.023), sleep (P = 0.022), overall feeling of well-being (P < 0.001), and higher morphine equivalent daily dose of opioid (median of 58 mg for unscheduled FU visits vs. 40 mg for scheduled FU visits; P = 0.054). Conclusion: Unscheduled new FU patients have higher levels of physical and psychosocial distress and higher opioid intake. Outpatient palliative care centers should consider providing opportunities for walk-in visits for timely management and close monitoring of such patients.
KW - Cancer
KW - Edmonton Symptom Assessment Scale
KW - opioids
KW - outpatient
KW - palliative care
KW - psychosocial distress
KW - unscheduled follow-ups
KW - unscheduled new patients
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U2 - 10.1016/j.jpainsymman.2018.01.015
DO - 10.1016/j.jpainsymman.2018.01.015
M3 - Article
C2 - 29410087
AN - SCOPUS:85043455339
SN - 0885-3924
VL - 55
SP - 1327
EP - 1334
JO - Journal of pain and symptom management
JF - Journal of pain and symptom management
IS - 5
ER -