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Concurrent palliative care reduced symptom burden in prostate cancer
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VANCOUVER — Symptom co-management delivered alongside oncologic and/or surgical care improved physical, psychological and existential outcomes for men with prostate cancer regardless of disease stage.
In results presented at the 2011 AAHPM & HPNA Annual Assembly, Michael Rabow, MD, director of the System Management Service at the Helen Diller Family Comprehensive Cancer Center at the University of California at San Francisco, said men in the study reported improvements in fatigue (P=.02); anxiety (P<.01); depression (P<.01); quality of life (P<.01) and spiritual well-being (P<.01) after 2 months of treatment at an outpatient palliative care co-management clinic.
“These results show that outpatient palliative care co-management for patients with prostate cancer is feasible,” Rabow said. “Patients are highly satisfied and see it as a reason to recommend the medical center to others.”
From May 2007 to May 2010, oncologists referred 96 men with prostate cancer to an outpatient palliative care co-management clinic for palliation concurrent with oncologic or surgical treatment. Patients completed the Edmonton Symptom Assessment Scale and the Steinhauser spirituality screen at each palliative care visit. Assessments were taken at baseline and again at 2 months.
Eighteen separate physicians referred patients. Median age in the cohort was 67 years and 57.3% had metastatic disease. The median number of visits to the palliation clinic was 1.21 per patient and 18 patients had at least two visits.
Survey results showed that men with local cancer were more likely to be concerned about sexual function, whereas men with metastatic disease were more concerned with mortality. Rabow said those answers were to be expected, but added that 40% of men with curable disease had concerns about dying.
“Men with localized prostate cancer, nevertheless, are burdened by significant emotional distress and mortality concerns,” he said. “Even patients who are not at the end-of-life may still have pronounced palliative care needs and appreciate help in addressing them.”
Rabow said the study had several limitations, including a small sample size, possible referral bias and scale validation, but these results warrant further study in a clinical trial.
For more information:
- Rabow M. #411-A. Presented at: the 2011 Annual Assembly of the American Academy of Hospice and Palliative Medicine; Feb. 16-19, 2011; Vancouver, Canada.
Disclosure: Dr. Rabow reports no relevant financial disclosures.