Barriers to symptom management in oncology.

Abstract

9083 Background: Optimal symptom management is a critical aspect of supportive care in cancer. Patient-reported outcomes such as QOL can be negatively impacted by uncontrolled symptoms such as pain and fatigue. Research suggests that barriers (patient, professional, systems-related) to symptom management hinder the quality of supportive cancer care. Methods: This NCI-supported prospective study assessed barriers to pain and fatigue management in a cohort (n=280) of cancer patients. The sample included breast (39%), lung (26%), colon (20%), and prostate (15%) cancer patients with moderate to severe (4-10) rating of pain and/or fatigue. Instruments included the COH-QOL questionnaire, Piper Fatigue Scale (PFS), Barriers to Pain and Fatigue questionnaires, and Patient Knowledge tools for Pain and Fatigue. Results: Mean age was 60, and 36% represented ethnic minorities. Half of the subjects had stage IV disease, and 80% were receiving cancer treatment. QOL concerns were identified for the psychological well-being (impact of cancer on appearance, changes in self-concept, distress from initial diagnosis and treatments, fear of recurrence), social well-being (family distress, interference with daily activities), and spiritual well-being (uncertainty) domains. Subjects reported high levels of distress from fatigue that interfered with daily functions. Patients believed in the importance of communicating pain and fatigue issues with clinicians, but barriers persisted for beliefs regarding pain medication addiction and the lack of effective fatigue treatments. Overall, patient knowledge of pain and fatigue was high, but lack of knowledge persisted for addiction, withdrawal, side effects of pain medications, and avoiding exercise for fatigue. Significant system-related changes occurred through dissemination of patient education materials, advocacy posters, professional education, clinical feedback, and increased referrals to supportive care services. Conclusions: Barriers to optimal symptom management persist for cancer patients who are actively receiving treatments. Structured patient and professional education coupled with system-wide dissemination of awareness can reduce barriers to symptom management and maintain QOL for cancer patients. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Genentech, Lilly