University of South Florida College of Medicine Tampa, FL
M. Tahbaz1, E. Keit2, H. Jim3, and R. H. Nanda Jr2; 1Department of Medical Education, Morsani College of Medicine, University of South Florida, Tampa, FL, 2H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL, 3Moffitt Cancer Center, Tampa, FL
Purpose/Objective(s): Palliative medicine as a component of comprehensive oncology care has been shown to reduce symptom burden and prolong overall survival in patients with advanced cancer. The Edmonton Symptom Assessment Scale (ESAS) is a validated tool for assessing patient well-being and has been studied as a clinical tool for identifying advanced cancer patients with significant need for palliative care. Our study investigated the characteristics and trends in ESAS scores of radiation oncology patients who underwent outpatient palliative care treatment at a community hospital. Materials/
Methods: We conducted a retrospective cohort study of radiation oncology patients receiving outpatient palliative care treatment at a community hospital between July 2020 and December 2022. Patients completed a modified ESAS tool with 13 possible symptom domains on a 10-point scale at the initial palliative care consult and at each follow-up visit. Total modified ESAS scores were calculated at initial consult and last follow-up to determine the net change. Demographic and individual patient data were obtained from the electronic medical record. Patients without a subsequent clinical encounter and corresponding ESAS score were excluded from analysis of ESAS score trends. Results: We identified a cohort of 57 radiation oncology patients who underwent outpatient palliative care treatment between July 2020 and December 2022, 30 (52.63%) of which were male. The majority of the cohort underwent radiation therapy with a curative plan intent (53 patients, 92.98%). The most common treatment sites were the brain (15 patients, 26.32%), thoracic cavity (13 patients, 22.81%), and spine (7 patients, 12.28%). The most common primary tumor site was the lung (14 patients, 24.56%). Over half of the patients had stage IV disease (32 patients, 56.14%). The average number of hospitalizations or emergency department (ED) visits from the onset of palliative care treatment to three months within last follow-up was 2.02 +/- 3.27 (Range 0-15). 32 out of the total 57 patients had >1 palliative care visit; the mean total modified ESAS score at initial consult for these patients was 44.60 +/- 22.92 (Range 5-90), while the mean total modified ESAS score at last follow-up was 34.73 +/- 24.26 (Range 0-85). The average net change in total modified ESAS score was -7.65 points +/- 27.16 (Range -68-80). The highest symptom domain scores were pain (5.00 +/- 2.77), tiredness (4.93 +/- 2.42), and difficulty sleeping (4.00 +/- 2.98). Conclusion: Our study demonstrated that most radiation oncology patients undergoing outpatient palliative care had clinically advanced disease with significant symptom burden. Total modified ESAS scores decreased throughout the course of palliative care treatment. Future studies may investigate the effect of palliative care on the number of hospitalizations/ED visits in this patient population.
