title: Impact of a palliative care consultation team on cancer-related symptoms in advanced cancer patients referred to an outpatient supportive care clinic.
abstract: BACKGROUND
  Patients with advanced cancer may develop severe physical and psychosocial symptoms. There are limited data on the impact of an outpatient palliative consultation (PC) team on cancer-related symptoms.
  
  
  OBJECTIVE
  To study the impact of the PC on symptoms in patients with advanced cancer receiving outpatient palliative care.
  
  
  METHODS
  Four hundred six consecutive patients referred to a supportive care outpatient center (OPC) from January 2006 to June 2007 with complete Edmonton Symptom Assessment Scale (0-10 scale) at the initial and follow-up visits were reviewed. Patient characteristics, change of symptoms at follow-up visit, and response rate were analyzed. Using logistic regression models, the predictors of improvement of pain and fatigue were assessed.
  
  
  RESULTS
  Median age was 59 years; 53% were female. Median interval between visits was 15 days. Mean scores at baseline and follow-up visits were fatigue 6.8 and 5.3 (P<0.0001), pain 5.3 and 4.1 (P<0.0001), depression 3.2 and 2.5 (P<0.0001), anxiety 3.7 and 2.8 (P<0.0001), dyspnea 2.7 and 2.5 (P=0.05), sleep 5 and 4 (P<0.0001), and well-being 5.2 and 4.4 (P<0.0001). Dyspnea (odds ratio and P-value, 0.90, 0.03), nausea (0.92, 0.06), and depression (0.91, 0.04) were associated with improvement in fatigue; drowsiness (1.10, 0.04), and feeling of well-being (0.87, 0.02) were associated with improvement in pain.
  
  
  CONCLUSIONS
  The initial consult by PC achieved significant symptom improvement in patients receiving treatment in the OPC. Further prospective studies are needed.
authors.affiliation: The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Sriram
authors.initials: S
authors.lastname: Yennurajalingam
authors.forename: Diana L
authors.initials: DL
authors.lastname: Urbauer
authors.forename: Katie L B
authors.initials: KL
authors.lastname: Casper
authors.forename: Cielito C
authors.initials: CC
authors.lastname: Reyes-Gibby
authors.forename: Ray
authors.initials: R
authors.lastname: Chacko
authors.forename: Valerie
authors.initials: V
authors.lastname: Poulter
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
mesh_terms: D000553:Ambulatory Care; D000554:Ambulatory Care Facilities; D001007:Anxiety / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D015984:Causality; D015897:Comorbidity; D005221:Fatigue / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D001068:Feeding and Eating Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000451:nursing*; D010146:Pain / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D010166:Palliative Care / Q000706:statistics & numerical data*; D010348:Patient Care Team / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D013727:Terminal Care; D013781:Texas / Q000453:epidemiology; D016896:Treatment Outcome