An exploratory pilot study of palliative medicine versus anesthesia-pain consultation for cancer pain.

Abstract

e19564 Background: Cancer-associated symptoms may be well managed by oncologists, though anesthesia-pain medicine (APM) and/or palliative medicine (PM) possess expertise in assessing and treating difficult symptoms. We compared PM vs. APM consultation in patients referred for “cancer pain management.” Methods: Patients referred to Anesthesia Cancer Pain Clinic over an 8-month period were evaluated by PM or APM randomly based on provider availability. PM and APM groups at baseline were comparable. Surveys including MD Anderson Symptom Inventory (MDASI) and Linear Analog Self Assessment were completed by all patients at baseline. Surveys were used by PM providers to assist with symptom and quality of life (QOL) assessment and treatment planning, but were not reviewed by APM providers. Follow up survey was completed by patients in person or by telephone 4-6 weeks after initial encounter as able. Data were analyzed on available-case basis with Wilcoxon Rank Sum test. Results: Sixty-two patients (37 PM, 25 APM, median age 61.2 y) completed initial survey with 48 (31 PM, 17 APM) completing follow up survey (6 unavailable, others expired—median survival 29 d). Mean pain score improved from 8 to 5.4 in PM group (P<0.001), 7.1 to 5.4 in the APM group (p<0.28). Disturbed sleep, anorexia, and mood showed statistically significant improvement in PM group, while others had a trend toward significance. Between PM and APM, a trend toward statistical significance was noted in nausea, disturbed sleep, and walking. PM demonstrated clinical significance (minimal important difference for MDASI = 1.2 point change) with 9/19 symptoms (PM) vs. 2/19 (APM). Twenty-four of 62 patients have since died with median survival 44 d. Conclusions: Cancer patients experience multiple symptoms including pain that adversely impact QOL. Though exploratory in design, these data suggest cancer pain and symptoms, QOL, and goals of care not requiring procedural intervention may be best suited for PM consultation over APM. Collective mortality in both groups was 39% at 157 d (range 6-157 d), suggesting poor prognosis in referred patients. Misconceptions of what PM entails may affect referral pattern; educational efforts are ongoing. No significant financial relationships to disclose.