TY - JOUR
T1 - Clinical response to an outpatient palliative care consultation in patients with advanced cancer and cancer pain
AU - Yennurajalingam, Sriram
AU - Kang, Jung Hun
AU - Hui, David
AU - Kang, Duck Hee
AU - Kim, Sun Hyun
AU - Bruera, Eduardo
PY - 2012/9
Y1 - 2012/9
N2 - Context: There is limited published data regarding the outcomes of palliative care consult on cancer pain treatment at the first follow-up visit. Objectives: The primary aim of this study was to determine pain treatment response to an outpatient palliative care consultation at the first follow-up visit for patients with cancer pain. Methods: Data from consecutive patients (n = 1612) who were referred to the outpatient Supportive Care Center at The University of Texas M. D. Anderson Cancer Center and completed the Edmonton Symptom Assessment System at their initial and subsequent visits from January 2003 to December 2010 were reviewed. All patients received interdisciplinary care led by palliative care specialists following an institutional protocol. Pain treatment response was defined as a ≥2 point or ≥30% reduction from baseline. Using logistic regression models, predictive factors associated with pain treatment response were assessed. Results: The mean (SD) baseline pain was 5.36 (2.9). Of the 1612 patients, 462 (29%) rated their pain as mild (numeric rating scale [NRS] score 0-3), 511 (32%) as moderate (NRS score 4-6), and 639 (39%) as severe (NRS score 7-10). Almost half (728 of 1612 [45%]) of the patients achieved pain treatment response. However, 228 of 728 (31%) responding patients still had pain ≥4 at the first follow-up visit in 15 days on average. Of the 462 patients with mild pain at baseline, 147 (32%) had worse pain at the first follow-up visit. Factors associated with clinical response were baseline pain intensity (odds ratio [OR] per point 1.4; P < 0.01), fatigue (OR per point 1.01; P = 0.014), and Edmonton Symptom Assessment System symptom burden (OR per point 1.01; P = 0.039). Conclusion: More than half of the patients with moderate/severe pain were nonresponders, and about one-third of the patients with mild pain had an increase in pain severity to moderate/severe levels at the first follow-up. More frequent follow-up visits, phone calls, and interdisciplinary clinics may improve pain control.
AB - Context: There is limited published data regarding the outcomes of palliative care consult on cancer pain treatment at the first follow-up visit. Objectives: The primary aim of this study was to determine pain treatment response to an outpatient palliative care consultation at the first follow-up visit for patients with cancer pain. Methods: Data from consecutive patients (n = 1612) who were referred to the outpatient Supportive Care Center at The University of Texas M. D. Anderson Cancer Center and completed the Edmonton Symptom Assessment System at their initial and subsequent visits from January 2003 to December 2010 were reviewed. All patients received interdisciplinary care led by palliative care specialists following an institutional protocol. Pain treatment response was defined as a ≥2 point or ≥30% reduction from baseline. Using logistic regression models, predictive factors associated with pain treatment response were assessed. Results: The mean (SD) baseline pain was 5.36 (2.9). Of the 1612 patients, 462 (29%) rated their pain as mild (numeric rating scale [NRS] score 0-3), 511 (32%) as moderate (NRS score 4-6), and 639 (39%) as severe (NRS score 7-10). Almost half (728 of 1612 [45%]) of the patients achieved pain treatment response. However, 228 of 728 (31%) responding patients still had pain ≥4 at the first follow-up visit in 15 days on average. Of the 462 patients with mild pain at baseline, 147 (32%) had worse pain at the first follow-up visit. Factors associated with clinical response were baseline pain intensity (odds ratio [OR] per point 1.4; P < 0.01), fatigue (OR per point 1.01; P = 0.014), and Edmonton Symptom Assessment System symptom burden (OR per point 1.01; P = 0.039). Conclusion: More than half of the patients with moderate/severe pain were nonresponders, and about one-third of the patients with mild pain had an increase in pain severity to moderate/severe levels at the first follow-up. More frequent follow-up visits, phone calls, and interdisciplinary clinics may improve pain control.
KW - Palliative care
KW - cancer pain
KW - interdisciplinary care
KW - pain management
KW - response rate
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U2 - 10.1016/j.jpainsymman.2011.09.014
DO - 10.1016/j.jpainsymman.2011.09.014
M3 - Article
C2 - 22699092
AN - SCOPUS:84865675529
SN - 0885-3924
VL - 44
SP - 340
EP - 350
JO - Journal of pain and symptom management
JF - Journal of pain and symptom management
IS - 3
ER -