Integration of palliative care in a multidisciplinary head and neck cancer clinic: A prospective cohort study.

Abstract

Integrated palliative care may improve outcomes in patients with cancer, but few studies have specifically evaluated its benefits in head and neck cancer. To assess changes in symptom control, quality of life, and supportive care needs in patients with head and neck cancer consecutively treated at a palliative care outpatient clinic over 12 months. Prospective cohort study. Symptoms were assessed at baseline and at 1.5, 3, 6, 9, and 12 months, and quality of life at baseline, 2, and 4 months. Symptom management was adjusted and referrals made as needed. Palliative care outpatient clinic integrated into the head and neck cancer unit of a comprehensive cancer center. Patients with head and neck cancer referred to this clinic who attended their first consultation were eligible. 118 patients (69.5% males; mean [SD] age 62.9 [10.5] years) were included. Most (91%) had active disease (85% receiving anti-cancer treatment). From baseline to month 12, improvements were observed in: average pain intensity (mean [95% CI]), 2.53 [2.09; 2.96] to 1.5 [0.86; 2.14]; total symptom distress score, 27.96 [25.35; 30.57] to 20.34 [16.63; 24.05]; anxiety, 1.86 [1.48; 2.24] to 1.14 [0.57; 1.7]; depression, 3.46 [3; 3.93] to 2.79 [2.13; 3.45]. Quality of life improved from baseline to month 4. Referral rates to supportive care were: social work (50%), psycho-oncology (21%), psychiatry (12%). Patients managed at a dedicated palliative care outpatient clinic showed improvements in symptom control and quality of life over time, which may reflect the contribution of integrated palliative care in the ambulatory setting.