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01-01-2017 | Original Article

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

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

Published in: Supportive Care in Cancer | Issue 1/2017

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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Title: Impact of outpatient palliative care (PC) on symptom burden in patients with advanced cancer at a tertiary cancer center in Jordan
Authors: Omar Shamieh
Odai Khamash
Mustafa Khraisat
Omar Jbouri
Mohammad Awni
Abdulrahman Al-Hawamdeh
Ghadeer Arja
Sawsan Ajarmeh
Dalia Al-Rimawi
David Hui
Publication date: 01-01-2017
Publisher: Springer Berlin Heidelberg
Published in: Supportive Care in Cancer / Issue 1/2017
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-016-3395-8

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