TY - JOUR
T1 - Impact of outpatient palliative care (PC) on symptom burden in patients with advanced cancer at a tertiary cancer center in Jordan
AU - Shamieh, Omar
AU - Khamash, Odai
AU - Khraisat, Mustafa
AU - Jbouri, Omar
AU - Awni, Mohammad
AU - Al-Hawamdeh, Abdulrahman
AU - Arja, Ghadeer
AU - Ajarmeh, Sawsan
AU - Al-Rimawi, Dalia
AU - Hui, David
N1 - Publisher Copyright:
© 2016, Springer-Verlag Berlin Heidelberg.
PY - 2017/1/1
Y1 - 2017/1/1
N2 - 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.
AB - 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.
KW - Advance cancer
KW - ESAS
KW - Jordan
KW - KHCC
KW - Out-patient clinic
KW - Palliative care
KW - Symptoms
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U2 - 10.1007/s00520-016-3395-8
DO - 10.1007/s00520-016-3395-8
M3 - Article
C2 - 27604806
AN - SCOPUS:84986325674
SN - 0941-4355
VL - 25
SP - 177
EP - 183
JO - Supportive Care in Cancer
JF - Supportive Care in Cancer
IS - 1
ER -