Yennurajalingam, S., Kang, J.H., Hui, D., Kang, D.H., Kim, S.H., & Bruera, E. (2012). Clinical response to an outpatient palliative care consultation in patients with advanced cancer and cancer pain. Journal of Pain and Symptom Management, 44, 340–350.

To determine response to pain treatment with outpatient palliative care consultation

Records of consecutive patients referred to an outpatient palliative care consultation program were reviewed for analysis. The palliative care service was provided by an interdisciplinary team led by a board-certified palliative care specialist. Care follows a standardized management plan. Symptoms were evaluated at baseline and follow-up visits. Findings between individuals who had consultation only versus those who had consultation with follow-up were compared.

• The study reported on a sample of 1,869 patients.
• Mean patient age was 59.2 years.
• The sample was 52% male and 48% female.
• Multiple different disease types were represented. 
• The most severe symptoms were pain and fatigue.
• Patients who had consultation only had significantly lower symptom severity scores.

• Single site
• Outpatient setting
• The University of Texas MD Anderson Cancer Center

• Patients were undergoing multiple phases of care.
• The study has clinical applicability for palliative care.

A retrospective, descriptive design was used.

• Edmonton Symptom Assessment Scale
• Pain “responders” defined as those achieving at least a three-point pain severity reduction

More than half (53%) of patients did not achieve a pain response, and 70% of those with moderate to severe pain at the initial visit did not respond to palliative care consultation or still had poor pain control at a follow-up visit. Thirty-two percent of those with mild pain and 27% with moderate pain had worse pain at follow-up. Median time to follow-up visits was 15 days. Factors associated with pain treatment response were baseline pain intensity, fatigue, and total symptom burden at baseline (p < 0.04).

Findings show that pain was not effectively controlled in the short-term with this program. Pain intensity can change quickly in the short-term. Standardized care as examined here may be an insufficient way to effectively manage pain.

• The study has risk of bias due to no control group, no blinding, no random assignment, and no appropriate attentional control condition.
• The study has risk of bias due to the sample characteristics.
• Unintended interventions or applicable interventions are not described that would influence results.
• Retrospective descriptive nature of the study is limiting but does provide some information regarding this type of program.
• It is not known if recommendations made from consultation were implemented, such as any changes in pain medications, etc.

This study provides only limited information about effectiveness of outpatient palliative care consultation for pain control; however, it does show that pain can get worse quickly, a large percentage of patients did not have adequate pain control, and the use of standard protocols may not be sufficient. Findings point to the need for aggressive pain management, frequent assessment of pain, and the potential need for very frequent follow-up in initial phases of establishing a pain management plan for the patient in order to quickly achieve pain reduction.