December 2003
Dear Readers: Here's the Article for this Month:
Name of article:
SYMPTOMS AND CONCERNS AMONGST CANCER OUTPATIENTS: IDENTIFYING THE NEED FOR SPECIALIST PALLIATIVE CARE
Author(s): V Lidstone, E Butters, PT Seed, C Sinnott, T Beynon, M Richards
Palliative Medicine 2003; 17: 588-595
Abstract:
According to the Expert Advisory Groups on Cancer (Department of Health, London), Specialistic Palliative Care (SPC) services should not be considered an “optimal extra,” but should be available to all cancer patients and integrated into the oncological services with the aim to ensure symptom control and quality of life.
Actually, it is more frequent to see the organization of hospital SPC teams aimed at caring for inpatient cancer population and for planning and allocation of resources dedicated to SPC in the outpatient setting, notwithstanding the higher number of patients.
The main aim of this study was to define the need for SPC in the cancer outpatient setting. The prevalence and severity of symptoms and concerns in the outpatient population, which attended a large cancer centre in London, was assessed by means of a validated assessment tool “Symptoms and Concerns Checklist”. The Checklist is formed by 29-items: 15 items related to physical, psychological or cognitive problems; 14 items related to other concerns. Patients rated the intensity of each symptom/concern item over the previous week by means of a 4-point scale (from 0 =not at all to 3 = very much).
Sixty patients from each of 8 tumour groups (lung, breast, GI, gynaecological, urological, head & neck, lymphoma, brain), and in any stage of disease (early/non advanced, remission, advanced), were recruited.
The most frequent symptoms in descending order were fatigue (79%), worries or concerns about the future and being unable to do things (57%), feeling tense/worried/fearful (56%), pain (53%), problems related to the oral cavity (50%).
The mean number of symptoms/concerns reported by each patient with advanced disease was 11.4 +/- 5.6, and 7.6 (+/- 4.6) in patients in first remission after treatment. Over a third of patients in remission reported physical and emotional symptoms such as fatigue, pain, shortness of breath, sleep disturbances, depression, concerns about the future.
The highest number of problems was reported, in decreasing order, by patients with lung, brain, breast, GI, head/neck cancers. In patients with gynaecological and urological cancers, or lymphoma the number of symptoms/concerns was significantly lower. The number of items reported by patients undergoing radio/chemotherapy and that reported by patients not under treatment was superimposable. Elderly patients mainly had the same physical symptoms as those of younger patients but reported
fewer psychosocial concerns.
Why I chose this article.
Notwithstanding the high number of ambulatory cancer patients that could use appropriate SPC, the planning, organization and resource allocation for SPC services are still very limited in the outpatient settings.
The results of this study suggest the need for symptom control and quality of life improvement for cancer outpatients. These results indicate that Specialistic Palliative Care should not be reserved only for advanced and terminal cancer patients.
Regards,
Carla Ripamonti, MD
Member of the Board of Directors, IAHPC
