title: Palliative and oncologic co-management: symptom management for outpatients with cancer.
abstract: OBJECTIVE
  Although outpatient palliative care clinics are increasingly common, evidence for their efficacy remains limited.
  
  
  METHODS
  We conducted an observational study at the palliative care clinic of an academic cancer center to assess the association between palliative care co-management and symptoms and quality of life. Two hundred sixty-six adult outpatients were seen for a minimum of two palliative care visits within 120 days. A subset of 142 patients was seen for a third visit within 240 days. Patients completed a questionnaire containing validated symptom, quality of life, and spiritual wellbeing questions at each visit.
  
  
  RESULTS
  The first follow-up visit was on average 41 days after the initial visit; the second follow-up visit was on average 81 days after the initial visit. Between the initial and first follow-up visits, there was significant improvement in pain (p < 0.001), fatigue (p < 0.001), depression (p < 0.001), anxiety (p < 0.001), quality of life (p = 0.002), and spiritual wellbeing (p < 0.001), but not nausea (p = 0.14). For the subset of patients seen for a second follow-up visit, the improvements in pain, fatigue, depression, anxiety, quality of life, and spiritual wellbeing persisted (p ≤ 0.005 for trend of each symptom). Patients had similar improvement regardless of their gender, age, ethnicity, disease stage, disease progression, and concurrent oncologic treatments.
  
  
  CONCLUSIONS
  Palliative care was associated with significant improvement in nearly all the symptoms evaluated. A sustained change in symptoms was observed in the subset of patients seen for a second follow-up visit. Members of all subgroups improved.
authors.affiliation: Department of Medicine, University of California, San Francisco, 1849 Oak Street, Upper Unit, San Francisco, CA, 94117, USA, kara.bischoff@ucsf.edu.
authors.forename: Kara
authors.initials: K
authors.lastname: Bischoff
authors.forename: Vivian
authors.initials: V
authors.lastname: Weinberg
authors.forename: Michael W
authors.initials: MW
authors.lastname: Rabow
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000523:psychology / Q000628:therapy; D003863:Depression / Q000523:psychology / Q000628:therapy; D018450:Disease Progression; D005221:Fatigue / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D009369:Neoplasms / Q000150:complications* / Q000523:psychology / Q000628:therapy*; D010045:Outpatients / Q000523:psychology*; D010146:Pain / Q000209:etiology / Q000523:psychology; D059408:Pain Management / Q000379:methods; D010166:Palliative Care / Q000379:methods*; D011788:Quality of Life; D011795:Surveys and Questionnaires