Originally published as JCO Early Release 10.1200/JCO.2008.17.7568 on December 8 2008

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Phase II Study of an Outpatient Palliative Care Intervention in Patients With Metastatic Cancer

Matthew Follwell, Debika Burman, Lisa W. Le, Kristina Wakimoto, Dori Seccareccia, John Bryson, Gary Rodin, Camilla Zimmermann

From the Departments of Radiation Oncology, Family and Community Medicine, and Psychiatry, and Division of Medical Oncology and Hematology, Department of Medicine, University of Toronto; and Departments of Psychosocial Oncology and Palliative Care and Biostatistics, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada

Corresponding author: Camilla Zimmermann, MD, MSc, Palliative Care Services, Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, 610 University Ave, 16-712, Toronto, Ontario, Canada, M5G 2M9; e-mail: camilla.zimmermann{at}uhn.on.ca

Purpose Although there is increasing advocacy for timely symptom control in patients with cancer, few studies have assessed outpatient palliative care clinics. This study assessed prospectively the efficacy of an Oncology Palliative Care Clinic (OPCC) in improving patient symptom distress and satisfaction.

Patients and Methods Eligible patients were new referrals to an OPCC, had metastatic cancer, were at least 18 years old, and were well enough and able to speak and read English sufficiently to provide informed consent and complete questionnaires. Patients received a consultation by a palliative care team. The primary end points of symptom control and patient satisfaction were assessed using the Edmonton Symptom Assessment Scale (ESAS) and patient-adapted Family Satisfaction with Advanced Cancer Care (FAMCARE) scale at baseline, 1 week, and 1 month. Initial and follow-up scores were compared using paired t tests.

Results Of 150 patients enrolled, 123 completed 1-week assessments, and 88 completed 4-week assessments. At baseline, the mean ESAS Distress Score (EDS) was 39.5. The mean improvement in EDS was 8.8 points (P < .0001) at 1 week and 7.0 points (P < .0001) at 1 month. Statistically significant improvements were observed for pain, fatigue, nausea, depression, anxiety, drowsiness, appetite, dyspnea, insomnia, and constipation at 1 week (all P .005) and 1 month (all P .05). The mean improvement in FAMCARE score was 6.1 points (P < .0001) at 1 week and 5.0 points (P < .0001) at 1 month.

Conclusion This phase II study demonstrates efficacy of an OPCC for improvement of symptom control and patient satisfaction with care. Randomized controlled trials are indicated to further evaluate the effectiveness of specialized outpatient palliative care.

published online ahead of print at www.jco.org on December 8, 2008

Supported by Grant No. NCIC 017257 (C.Z.) from the National Cancer Institute of Canada, with funds from the Canadian Cancer Society.

Presented in part at the 43rd Annual Meeting of the American Society of Clinical Oncology, June 1-5, 2007, Chicago, IL, and at the International Psycho-Oncology Society 9th World Congress of Psycho-Oncology, September 16-20, 2007, London, United Kingdom.

The funding agency had no role in the design or conduct of the study; the collection, analysis, or interpretation of the data; or the preparation, review, or approval of the article.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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