BPI22-020: Better Together: Why Palliative Care Should be Incorporated Early in Patients With Advanced Head and Neck Cancer

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  • 1 University of Texas Southwestern Medical Center, Dallas, TX
  • | 2 C. Simmons Comprehensive Cancer Center, Dallas, TX
  • | 3 Parkland Health & Hospital System, Dallas, TX
  • | 4 University of Texas Southwestern Medical Center, Dallas, TX

Background: Advanced head and neck cancers often necessitate intensive treatment regimens in pursuit of a cure. These cancers and their treatments frequently lead to significant symptom burden, impacting many patients’ overall quality of life. Moreover, these patients have unique symptoms that other cancer patients typically do not experience, including sialorrhea, xerostomia, odynophagia, and dysphagia. Without a structured approach, the identification and management of these distressing symptoms prove to be difficult. Palliative care providers help elucidate and treat these complex symptoms, but are often not consulted until late into a patient’s cancer journey. An ideal opportunity remains for palliative care providers to add value to the multidisciplinary team by offering a structured approach early in the course of treatment in patients with advanced head and neck cancer. Methods: A palliative care physician was embedded into an otolaryngology complex cancer clinic that treats advanced head and neck cancer patients with curative intent. Palliative care was routinely consulted and used a traditional Edmonton Symptom Assessment Scale (ESAS) that was modified to add additional elements to address the unique symptoms of this population. ESAS scores of ≥4 indicated moderate symptoms and scores of ≥7 represented severe symptoms. Results: The modified ESAS scores were obtained from the initial consultation of 21 patients over 6 months, all of whom received palliative care early in their diagnosis. Pain was the most distressing symptom, where 13/21 patients had severe pain with an average modified ESAS score of 6. Fatigue, odynophagia, sense of wellbeing, and dysphagia were amongst the other symptoms with average modified ESAS scores of ≥4. Moderate to severe anxiety or depression was found in 10/21 patients. Conclusions: This embedded palliative care model illustrates how utilizing concurrent palliative care can allow for earlier symptom identification in advanced head and neck cancer patients. Early identification can lead to prompt symptom management and overall improvement in the patient’s quality of life. Redesigning standard tools like our modified ESAS can better assess symptoms unique to this cancer population. As these symptoms change throughout the patient’s cancer treatment, these results further strengthen the value of incorporating palliative care at the start of curative treatment in patients with advanced head and neck cancer.

Corresponding Author: Vishal Kapadia, DO
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