A Shared Symptom Burden Presents Opportunities for Collaboration between Outpatient Palliative Care and Psycho-Oncology Providers

Transcription

1 A Shared Symptom Burden Presents Opportunities for Collaboration between Outpatient Palliative Care and Psycho-Oncology Providers NICOLE BATES, MD, PGY-IV PSYCHIATRY RESIDENT WESTERN PSYCHIATRIC INSTITUTE AND CLINIC APRIL 21, 2018

2 Learning Objectives By the completion of this session, participants should be able to: Identify symptoms shared by cancer patients presenting for psycho-oncology and palliative care outpatient services. Discuss correlations between physical and mental health symptoms reported in patients presenting for outpatient psycho-oncology services at an academic medical center. Describe a rationale for greater collaboration between psycho-oncology and palliative care outpatient clinics in addressing physical and mental health symptoms.

3 Common Ground: Oncology, Psychiatry, and Palliative Care Palliative Care Psychiatry Physical Symptoms Depression Anxiety Cognition Care of Cancer Patients

4 Our Clinical Experience Significant Symptoms Referrals from Palliative Care Suspected Referral Gap to PC Need to Collaborate

5 Study Objectives Patient Symptoms Characterize depressive, anxious, physical, and functional symptoms in psycho-oncology patients Palliative Care Determine receipt of proximal outpatient palliative care services Correlations Explore associations between depressive, anxious, and physical symptoms and receipt of palliative care services.

6 Methods Subjects UPMC Center for Counseling and Cancer Support Cancer patients completing intake surveys Feb Dec, 2016 Captured patient demographics and cancer status Survey Depression: Patient Health Questionnaire-9 item (PHQ-9) Anxiety: Generalized Anxiety Disorder-7 (GAD-7) Physical/functional symptoms: Hybrid ESAS & MDAS Palliative Care Receipt of palliative care via EMR review Study timeframe limited to 6 months before and after survey completion Analysis Descriptive reporting of patient baseline characteristics and symptoms Pearson correlation for association between symptoms Two-sample t-tests and one-way ANOVA comparisons

7 Patient Characteristics Characteristic Number (%), n = 134 Mean age, years (range) 56 (20-80) Cancer Type Female 82 (61.2%) Race Caucasian African American Asian Other or not reported Cancer Stage Stage 0, in situ Stage 1, local Stage 2/3 (A/B), regional Stage 4, distant Not staged Do not know 119 (88.8%) 12 (9.0%) 1 (0.7%) 2 (1.5%) 7 (5.2%) 15 (11.2%) 38 (28.4%) 38 (28.4%) 15 (11.2%) 21 (15.6%) Characteristic Breast Hematologic Gastrointestinal Lung Colorectal Melanoma/skin Head/neck Brain/CNS Prostate Gynecologic Other Referral Source Oncology/Hematology Palliative care Mental health Other medical provider Self Other Unknown Number (%), n = (23.1%) 16 (11.9%) 15 (11.2%) 14(10.4%) 13 (9.7%) 11 (8.2%) 11 (8.2%) 10 (7.5%) 3 (2.2%) 3 (2.2%) 7 (5.2%) 94 (70.1%) 15 (11.2%) 6 (4.5%) 3 (2.2%) 9 (6.7%) 1 (0.7%) 6 (4.5%)

8 Presenting Psychiatric Symptoms Measure Mean Score (SD) Moderate to Severe Pearson Correlations Physical Sx p- value* PHQ (6.3) 58 (43.3%).618 <.001 GAD (6.3) 62 (46.3%).314 <.001 Physical Symptoms 26.3 (16.3) See Figure 1 1 -

9 Presenting Physical Symptoms FATIGUE 74.6% SLEEP 51.5% PAIN MEMORY APPETITE 37.3% 36.6% 43.3% NUMBNESS NAUSEA CONSTIPATION DIARRHEA 23.1% 22.4% 16.4% 15.7% VOMITING 8.2% Number of Patients Reporting Moderate to Severe Symptoms (n = 134)

10 Receipt of Palliative Care 22.4% Number of Patients (n=134) 14.2% 5.2% 1.5% 1.5% ANY, ±6 MONTHS FROM SURVEY DATE 3-6 MONTHS BEFORE <3 MONTHS BEFORE <3 MONTHS AFTER 3-6 MONTHS AFTER Palliative Care Involvement Relative to Psycho-oncology Intake Survey

11 Symptom Burden by Palliative Care Status Measure Mean Score (SD) Any PC (n = 30) No PC (n= 104) t Equality of Means p- value PHQ (7.15) 9.1 (5.82) GAD (6.18) 9.3 (6.35) Physical 39.3 Symptoms (15.95) 22.6 (14.42) <0.001 Mean Diff (SE) (1.425) (1.309) (3.062)

12 Do Symptoms Differ Across Palliative Care Status? No palliative care Palliative care within 6 months before Palliative care within 6 months after Mean Score PHQ-9 GAD-7 PHYSICAL SYMPTOMS

13 Do Symptoms Differ Across Palliative Care Status? p = No palliative care Palliative care within 6 months before Palliative care within 6 months after p < p = NS Mean Score p = PHQ-9 GAD-7 PHYSICAL SYMPTOMS

14 Conclusions Patients Both depressive and physical symptomatology appear more severe in oncology patients receiving concurrent outpatient palliative and psycho-oncology services Successes Outpatient psycho-oncology patients engaged with palliative care appear appropriately referred Weaknesses Palliative care appears under-utilized in our population Limited timeframe and referral tracking to palliative care Opportunities Our findings underscore the need for care collaboration between outpatient psycho-oncology and palliative care

15 References 1. Teunissen, S.C.C.M. et al., Are anxiety and depressed mood related to physical symptom burden? A study in hospitalized advanced cancer patients. Palliative Medicine, 21(4): Patterson, K.R. et al., Current state of psychiatric involvement on palliative care consult services: results of a national survey. Journal of Pain and Symptom Management, 47(6) : Ogawa A, et al., Availability of psychiatric consultation-liaison services as an integral component of palliative care programs at Japanese cancer hospitals. Japanese Journal of Clinical Oncology, 42(1): Hannon B, et al., Modified Edmonton Symptom Assessment System including constipation and sleep: validation in outpatients with cancer. Journal of Pain and Symptom Management, 49(5): Cleeland C.S. et al., Assessing symptom distress in cancer patients. Cancer, 89:

16 Thanks and Questions Carissa Low, PhD Andrea Croom, PhD Linda King, MD Kaleena Chilcote, MD Ms. Tiffiany Dotson Dionysios Kavalieratos, PhD Heidi Patterson, MLIS WPIC Consultation-Liaison Psychiatry