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Characteristics of patients with advanced lung cancer referred to a rapid-access supportive care clinic

Published online by Cambridge University Press:  22 July 2016

Sriram Yennurajalingam ,
Zhanni Lu ,
Janet L. Williams ,
Diane D. Liu ,
Joseph Anthony Arthur  and
Eduardo Bruera
Sriram Yennurajalingam*
Affiliation:
Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
Zhanni Lu
Affiliation:
Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
Janet L. Williams
Affiliation:
Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
Diane D. Liu
Affiliation:
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
Joseph Anthony Arthur
Affiliation:
Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
Eduardo Bruera
Affiliation:
Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
*
Address correspondence and reprint requests to Sriram Yennurajalingam, Department of Palliative, Rehabilitation, and Integrative Medicine, Unit 1414, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030. E-Mail: [email protected].
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Abstract

Objective:

There is a limited number of pragmatic studies to evaluate the criteria for referral to outpatient palliative care. The aim of our study was to compare the characteristics, symptoms, and survival of patients with advanced non-small-cell lung cancer (NSCLC) referred (RF) versus not referred (NRF) to a novel embedded same-day rapid-access supportive care clinic (RASCC) and to compare the subgroups among referred patients.

Method:

We reviewed the medical records of all patients who received treatment at the thoracic oncology clinic for advanced non-small-cell lung cancer between August 1, 2012, and June 30, 2013, who were referred to the RASCC and those who were not referred. An oncology-estimated prognosis of ≤6 months and/or severe symptom distress was employed as criteria for referral to the RASCC.

Results:

Of 410 eligible patients, 155 (37.8%) were referred to the RASCC. RF patients had significantly higher patient-reported scores for pain, fatigue, lack of appetite, and symptom distress, as well as worse performance status and shorter survival than NRF patients. Among the RF patients, those who were referred early (≤3 months) had significantly worse symptom distress and shorter overall survival than patients who were referred later on. The patients treated by thoracic oncologists who referred a smaller proportion of their patients to the RASCC had significantly worse anxiety, well-being, spiritual pain, and symptom distress than patients treated by those who referred a larger proportion of their patients to the RASCC.

Significance of Results:

We found that patients who were referred to the RASCC had higher reported symptom distress and worse survival ratings. Further studies are needed to evaluate the optimal criteria for timely integration of palliative care and oncology care.

Keywords

Advanced non-small-cell lung cancerPalliative carePatient-reported symptom burdenPatient characteristicsSupportive care
Type
Original Articles
Information
Palliative & Supportive Care , Volume 15 , Issue 2 , April 2017 , pp. 197 - 204
Copyright
Copyright © Cambridge University Press 2016 

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Footnotes

*

These authors contributed equally.

References

REFERENCES

Bakitas, M., Lyons, K.D., Hegel, M.T., et al. (2009). Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer. The Journal of the American Medical Association, 302(7), 741–749.CrossRefGoogle ScholarPubMed
Bauman, J.R. & Temel, J.S. (2014). The integration of early palliative care with oncology care: The time has come for a new tradition. Journal of the National Comprehensive Cancer Network, 12(12), 1763–1771.Google ScholarPubMed
Bruera, E. & Yennurajalingam, S. (2012). Palliative care in advanced cancer patients: How and when? The Oncologist, 17(2), 267–273.CrossRefGoogle ScholarPubMed
Ewing, J.A. (1984). Detecting alcoholism: The CAGE Questionnaire. The Journal of the American Medical Association, 252, 1905–1907.CrossRefGoogle ScholarPubMed
Fadul, N., Elsayem, A., Palmer, J.L., et al. (2009). Supportive versus palliative care: What's in a name? Cancer, 115(9), 2013–2021.CrossRefGoogle Scholar
Garyali, A., Palmer, J.L., Yennurajalingam, S., et al. (2006). Errors in symptom intensity self-assessment by patients receiving outpatient palliative care. Journal of Palliative Medicine, 9(5), 1059–1065.CrossRefGoogle ScholarPubMed
Glare, P., Plakovic, K., Schloms, A., et al. (2013). Study using the NCCN guidelines for palliative care to screen patients for palliative care needs and referral to palliative care specialists. Journal of the National Comprehensive Cancer Network, 11(9), 1087–1096.CrossRefGoogle ScholarPubMed
Hui, D., Elsayem, A., de la Cruz, M., et al. (2010). Availability and integration of palliative care at U.S. cancer centers. The Journal of the American Medical Association, 303(11), 1054–1061.CrossRefGoogle ScholarPubMed
Kang, J.H., Kwon, J.H., Hui, D., et al. (2013). Changes in symptom intensity among cancer patients receiving outpatient palliative care. Journal of Pain and Symptom Management, 46(5), 652–660.CrossRefGoogle ScholarPubMed
Osta, B., Palmer, J., Paraskevopoulos, T., et al. (2008). Interval between first palliative care consult and death in patients diagnosed with advanced cancer at a comprehensive cancer center. Journal of Palliative Medicine, 11, 51–57.CrossRefGoogle Scholar
Reville, B., Miller, M.N., Toner, R.W., et al. (2010). End-of-life care for hospitalized patients with lung cancer: Utilization of a palliative care service. Journal of Palliative Medicine, 13(10), 1261–1266.CrossRefGoogle ScholarPubMed
Reyes-Gibby, C.C., Anderson, K.O., Shete, S., et al. (2012). Early referral to supportive care specialists for symptom burden in lung cancer patients. Cancer, 118(3), 856–863.CrossRefGoogle ScholarPubMed
Schenker, Y., Crowley-Matoka, M., Dohan, D., et al. (2014). Oncologist factors that influence referrals to subspecialty palliative care clinics. Journal of Oncology Practice, 10(2), e37–e44.CrossRefGoogle ScholarPubMed
Temel, J.S., Greer, J.A., Muzikansky, A., et al. (2010). Early palliative care for patients with metastatic non-small-cell lung cancer. The New England Journal of Medicine, 363(8), 733–742.CrossRefGoogle ScholarPubMed
Weissman, D.E. & Meier, D.E. (2010). Identifying patients in need of a palliative care assessment in the hospital setting: A consensus report from the center to advance palliative care. Journal of Palliative Medicine, 14(1), 17–23.CrossRefGoogle ScholarPubMed
Wentlandt, K., Krzyzanowska, M.K., Swami, N., et al. (2012). Referral practices of oncologists to specialized palliative care. Journal of Clinical Oncology, 30(35), 4380–4386. Epub ahead of print Oct 29.CrossRefGoogle ScholarPubMed
Yennurajalingam, S., Urbauer, D.L., Casper, K.L.B., et al. (2011). Impact of a palliative care consultation team on cancer-related symptoms in advanced cancer patients referred to an outpatient supportive care clinic. Journal of Pain and Symptom Management, 41(1), 49–56.CrossRefGoogle Scholar
Zimmermann, C., Swami, N., Krzyzanowska, M., et al. (2014). Early palliative care for patients with advanced cancer: A cluster-randomised controlled trial. The Lancet, 383(9930), 1721–1730.CrossRefGoogle Scholar
Zubrod, C.G. (1960). Appraisal of methods for the study of chemotherapy of cancer in man: Comparative therapeutic trial of nitrogen mustard and triethylene thiophosphoramide. Journal of Chronic Disease, 11(1), 7–33.CrossRefGoogle Scholar