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Use of specialty palliative care was linked to reductions in pain in adolescents and young adults (AYAs) with cancer in a new study. These study results were published in JAMA Network Open.
The study was a cohort analysis that included AYAs in Ontario, Canada, ages 15 through 29 years. They had received a primary cancer diagnosis between January 1, 2010, and June 30, 2018. The researchers analyzed patients’ self-reported scores on the Edmonton Symptom Assessment System (ESAS) that were available through healthcare databases. The use of SPC visits was identified through analyses of billing codes.
Primary outcomes of the study were the time to first general or specialty palliative care visit. The researchers also analyzed changes in symptoms reflected in ESAS scores with the use of palliative care in patients who had died within 5 years of diagnosis. The analysis of ESAS scores used a case-control design in which case patients were those who received the relevant form of palliative care and control patients did not.
The study included 5435 AYAs with cancer who were a median 25 years (IQR, 22-27) at cancer diagnosis. Median study follow-up times were 5.1 years (IQR, 2.5-7.9) for the analyses of general palliative care and 5.6 years (IQR, 3.1-8.2) for the analyses of specialty palliative care.
The 5-year cumulative incidence of the use of general palliative care was 26% (95% CI, 25%-27%), and the 5-year cumulative incidence of specialty palliative care use was 19% (95% CI, 18%-20%). Overall, within 5 years of the initial cancer diagnosis, 13.3% of the patients in this study had died. Among these patients, 90.4% had involvement of general palliative care and 84.9% received specialty palliative care.
Patients who had moderate or severe scores on the ESAS were more likely to involve general or specialty palliative care than were patients with mild scores. Significant changes were not observed with most symptoms, but both general and specialty palliative care were associated with statistically significant improvements in pain.
In the case patient population, the mean pain ESAS score was reduced from 3.40 to 2.95 following the use of general palliative care, compared with an increase of 1.44 to 1.73 in the control patient population who did not receive general palliative care in the corresponding time frame (P <.001).
For patients receiving specialty palliative care, the mean pain ESAS score changed from 3.41 to 3.07 in the case population and from 1.86 to 2.16 in the control population (P =.003).
“In this cohort study of AYAs with cancer, those reporting moderate or severe symptoms in the context of a provincial screening program were more likely to subsequently receive [palliative care] services, suggesting that such programs have a role in ensuring PC involvement for AYAs in need,” the researchers concluded.
Reference
Gupta S, Li Q, Kassam A, et al. Specialty palliative care and symptom severity and control in adolescents and young adults with cancer. JAMA Netw Open. 2023;6(10):e2338699. doi:10.1001/jamanetworkopen.2023.38699
