Impact of outpatient palliative care (PC) on symptom burden in patients with advanced cancer at a tertiary cancer center in Jordan.
Outpatient palliative care clinics are essential for early symptom management in patients with advanced cancer. Few outpatient programs are available in the Middle East. In this prospective study, we examined the symptom changes among cancer patients seen at a palliative care clinic in Jordan.



Patients with advanced cancer who had an outpatient palliative care consultation and not delirious were enrolled. The Edmonton Symptom Assessment System (ESAS), Karnofsky Performance Scale (KPS), and Memorial Delirium Assessment Scale (MDAS) were collected at consultation and follow up visit 14-34 days later. We compared symptom changes using paired t test.



Among the 182 enrolled patients, the average age was 53 years, 47 % were females, and 95 % had stage IV cancer. The median duration between the two clinic visits was 21 days (interquartile range 15-28). KPS decreased between visits (mean 68 vs. 66 %, P = 0.004). ESAS pain (5.9 vs. 5.1, P = 0.004) and sleep (4.6 vs. 4.1, P = 0.007) improved significantly over time. The remaining ESAS symptoms decreased in intensity, albeit not statistically significant. Among patients who presented with moderate to severe symptom intensity, pain (7 vs. 6, P < 0.0001), fatigue (7 vs. 6, P = 0.003), nausea (7 vs. 4, P < 0.0001), depression (7 vs. 5, P = 0.0008), anxiety (7 vs. 5, P < 0.0001), drowsiness (6 vs. 5, P < 0.001), appetite (7 vs. 6, P = 0.0007), well-being (7 vs. 6, P < 0.0001), dyspnea (6 vs. 5, P = 0.0006), and sleep (7 vs. 5, P < 0.0001) all improved significantly.



Our outpatient palliative care consultation was associated with improvement in ESAS, particularly for patients who presented with moderate to severe symptoms. Further studies are needed to examine predictors of symptom response, longer term outcomes, and how to improve access to outpatient palliative care in the Middle East.
Department of Palliative Care, King Hussein Cancer Center, 202 Queen Rania Al Abdullah St., P.O.Box 1269, Al-Jubeiha, Amman, 11941, Jordan. oshamieh@khcc.jo.
Omar
0000-0002-3635-8624
O
Shamieh
Department of Palliative Care, King Hussein Cancer Center, 202 Queen Rania Al Abdullah St., P.O.Box 1269, Al-Jubeiha, Amman, 11941, Jordan.
Odai
O
Khamash
Department of Palliative Care, King Hussein Cancer Center, 202 Queen Rania Al Abdullah St., P.O.Box 1269, Al-Jubeiha, Amman, 11941, Jordan.
Mustafa
M
Khraisat
Department of Palliative Care, King Hussein Cancer Center, 202 Queen Rania Al Abdullah St., P.O.Box 1269, Al-Jubeiha, Amman, 11941, Jordan.
Omar
O
Jbouri
Department of Palliative Care, King Hussein Cancer Center, 202 Queen Rania Al Abdullah St., P.O.Box 1269, Al-Jubeiha, Amman, 11941, Jordan.
Mohammad
M
Awni
Department of Palliative Care, King Hussein Cancer Center, 202 Queen Rania Al Abdullah St., P.O.Box 1269, Al-Jubeiha, Amman, 11941, Jordan.
Abdulrahman
A
Al-Hawamdeh
Department of Palliative Care, King Hussein Cancer Center, 202 Queen Rania Al Abdullah St., P.O.Box 1269, Al-Jubeiha, Amman, 11941, Jordan.
Ghadeer
G
Arja
Department of Palliative Care, King Hussein Cancer Center, 202 Queen Rania Al Abdullah St., P.O.Box 1269, Al-Jubeiha, Amman, 11941, Jordan.
Sawsan
S
Ajarmeh
Department of Palliative Care, King Hussein Cancer Center, 202 Queen Rania Al Abdullah St., P.O.Box 1269, Al-Jubeiha, Amman, 11941, Jordan.
Dalia
D
Al-Rimawi
Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center , 1515 Holcombe Boulevard, Unit 1414, Houston, TX, 77030, USA.
David
D
Hui
D000553:Ambulatory Care; D000554:Ambulatory Care Facilities; D005260:Female; D006801:Humans; D007597:Jordan; D017567:Karnofsky Performance Status; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D010045:Outpatients; D010166:Palliative Care / Q000379:methods*; D011446:Prospective Studies; D012189:Retrospective Studies; D012720:Severity of Illness Index; D062606:Tertiary Care Centers
Advance cancer; ESAS; Jordan; KHCC; Out-patient clinic; Palliative care; Symptoms