Distress Screening in Head and Neck Cancer Patients Undergoing Active Cancer Directed Treatment and Impact of Referral to Psycho-Oncology and Palliative Care

e19613 Background: We previously examined factors associated with delayed PC referral. Little is known about the actual proportion of patients referred to PC. We determined the proportion of patients who had a PC consultation at our cancer center and the predictors of referral. Methods: All adult patients in the Houston area who died of advanced cancer between 9/1/2009 and 2/28/2010 while under the care of our institution were included. We collected baseline demographics and data on PC referral. Multivariate logistic regression was used to examine factors associated with PC referral. Results: 386/912 (42%) decedents had a PC referral, and 179 (46%) were seen initially as outpatients. In multivariate analysis, PC referral was associated with younger age (odds ratio (OR) 0.98 per year; 95% confidence interval (CI) 0.97-0.99; P<0.001), married status (OR 1.5; 1.1-2.0; P=0.005), and gynecologic cancer (OR 1.9, 1.1-3.5, P=0.02 relative to lung). Among patients with a PC referral, outpatient consultation was more likely among patients with head and neck cancer (OR=5.5, 1.7-17.6, P=0.004 relative to lung). In contrast, hematologic malignancy was associated with decreased PC referral (OR=0.59, 0.36-0.97, P=0.04), fewer outpatient PC consultations (OR=0.3, 0.1-0.7, P=0.01) and less time from referral to death (Table). Conclusions: Younger, married patients and those with gynecologic cancer were more like to be referred to palliative care. Head and neck cancer patients were more often seen as PC outpatients. Patients with hematologic malignancies had fewer PC referrals and often late in the disease trajectory compared to patients with solid tumors. [Table: see text]

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Effect of Early Palliative Care on Quality of Life of Advanced Head and Neck Cancer Patients: A Phase III Trial

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djab020 ◽

2021 ◽

Author(s):

Vijay Maruti Patil ◽

Pankaj Singhai ◽

Vanita Noronha ◽

Atanu Bhattacharjee ◽

Jayita Deodhar ◽

...

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Overall Survival ◽

Head And Neck Cancer ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

Phase Iii ◽

Early Palliative Care

Abstract Background Early palliative care (EPC) is an important aspect of cancer management but has never been evaluated in patients with head and neck cancer. Hence, we performed this study to determine whether the addition of EPC to standard therapy leads to an improvement in the quality of life (QOL), decrease in symptom burden and improvement in overall survival. Methods Adult patients with squamous cell carcinoma of the head and neck region planned for palliative systemic therapy, were allocated 1:1 to either standard systemic therapy without (STD arm) or with comprehensive EPC service referral (EPC arm). Patients were administered the revised Edmonton Symptom Assessment Scale (ESAS-r) and the Functional Assessment of Cancer Therapy for head and neck cancer (FACIT HN) questionnaire at baseline and every 1 month thereafter for 3 months. The primary endpoint was a change in the QOL measured at 3 months after random assignment. All statistical tests were 2-sided. Results Ninety patients were randomly assigned to each arm. There was no statistical difference in the change in the FACT-H&N total score (P = .94), FACT-H&N Trial Outcome Index (P = .95), FACT- G (general) total (P = .84) and ESAS-r scores at 3 months between the two arms. The median overall survival was similar between the two arms (Hazard ratio for death = 1.01, 95% CI = 0.74–1.35). There were 5 in-hospital deaths in both arms (5.6% for both, P = .99). Conclusions In this phase III study, the integration of EPC in head and neck cancer patients did not lead to an improvement in the QOL or survival.

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