title: Multidisciplinary team contributions within a dedicated outpatient palliative radiotherapy clinic: a prospective descriptive study.
abstract: OBJECTIVE
  Patients with bone metastases may experience pain, fatigue, and decreased mobility. Multiple medications for analgesia are often required, each with attendant side effects. Although palliative-intent radiotherapy (RT) is effective in decreasing pain, additional supportive care interventions may be overlooked. Our objective was to describe the feasibility of multidisciplinary assessment of patients with symptomatic bone metastases attending a dedicated outpatient palliative RT clinic.
  
  
  METHODS
  Consecutive patients referred for RT for painful bone metastases were screened for symptoms and needs relevant to their medications, nutritional intake, activities of daily living, and psychosocial and spiritual concerns from January 1 to December 31, 2007. Consultations by appropriate team members and resulting recommendations were collected prospectively. Patients who received RT were contacted by telephone 4 weeks later to assess symptom outcomes.
  
  
  RESULTS
  A total of 106 clinic visits by 82 individual patients occurred. As determined by screening form responses, the clinical Pharmacist, Occupational Therapist, Registered Dietician and Social Worker were consulted to provide assessments and recommendations within the time constraints presented by 1-day palliative RT delivery. In addition to pain relief, significant improvements in tiredness, depression, anxiety, drowsiness and overall well-being were reported at 4 weeks.
  
  
  CONCLUSIONS
  Systematic screening of this population revealed previously unmet needs, addressed in the form of custom verbal and written recommendations. Multidisciplinary assessment is associated with a high number of recommendations and decreased symptom distress. Our findings lend strong support to the routine assessment by multiple supportive care professionals for patients with advanced cancer being considered for palliative RT.
authors.affiliation: Cross Cancer Institute, Edmonton, AB, Canada. pituskin@ualberta.ca
authors.forename: Edith
authors.initials: E
authors.lastname: Pituskin
authors.forename: Alysa
authors.initials: A
authors.lastname: Fairchild
authors.forename: Jennifer
authors.initials: J
authors.lastname: Dutka
authors.forename: Lori
authors.initials: L
authors.lastname: Gagnon
authors.forename: Amy
authors.initials: A
authors.lastname: Driga
authors.forename: Patty
authors.initials: P
authors.lastname: Tachynski
authors.forename: Jo-Ann
authors.initials: JA
authors.lastname: Borschneck
authors.forename: Sunita
authors.initials: S
authors.lastname: Ghosh
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D001007:Anxiety / Q000628:therapy; D001859:Bone Neoplasms / Q000523:psychology / Q000532:radiotherapy* / Q000556:secondary; D016009:Chi-Square Distribution; D003863:Depression / Q000628:therapy; D004045:Dietary Services / Q000706:statistics & numerical data; D005221:Fatigue / Q000628:therapy; D005240:Feasibility Studies; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D009788:Occupational Therapy / Q000706:statistics & numerical data; D010146:Pain / Q000209:etiology / Q000523:psychology / Q000532:radiotherapy*; D010166:Palliative Care / Q000379:methods / Q000706:statistics & numerical data*; D010348:Patient Care Team / Q000458:organization & administration* / Q000706:statistics & numerical data; D010607:Pharmacy Service, Hospital / Q000706:statistics & numerical data; D011446:Prospective Studies; D012947:Social Work / Q000706:statistics & numerical data; D029181:Spirituality