Changes in symptom burden associated with exposure to outpatient palliative care in an integrated health system.

Abstract

204 Background: Patients with serious illnesses are often referred to palliative care (PC) for symptom management, advance care planning, and goals-of-care discussions. The purpose of this analysis is to describe the symptom burden (SB) and short-term changes in patients receiving outpatient PC from nine clinics within an integrated health system in Southern California. Methods: We included 3,007 adults with cancer who completed the Edmonton Symptom Assessment System (ESAS) at the start of PC from 1/1/14 - 6/30/18. Patients were identified at baseline as having either a high SB if they scored ≥ 4 on at least two out of nine symptoms or low SB if they did not meet this threshold. We compared baseline socio-demographic and clinical characteristics between high SB and low SB patients. We also examined changes in the ESAS for patients with a follow-up survey at 30 ± 14 days after baseline. Results: Patients with high SB at presentation to PC tended to be younger and had comparable co-morbidities to patients with low SB. Availability of a follow-up ESAS was low but similar between groups (18%). Changes in the ESAS met published minimal clinically important differences (MCID) for the high SB patients whereas low SB patients showed worsening symptoms. Conclusions: We observed similar symptom burden in this community-based oncology patient population as other studies from specialized cancer centers. Greater effort is needed to standardize timing of follow-up assessments and integrating personalized symptom goals.[Table: see text]