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

Abstract

Background: Integrated palliative care may improve outcomes in patients with cancer, but few studies have specifically evaluated its benefits in head and neck cancer.

Aim: 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.

Design: 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.

Setting and participants: 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.

Results: 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%).

Conclusions: 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.