Effect of palliative care services on quality of life over time among gynecologic oncology patients

Objectives: Palliative Care (PC) has been shown to be a beneficial adjunct to cancer therapy. This study aimed to compare the impact on the quality of life in attending a PC appointment among gynecologic oncology patients utilizing the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire over time. Methods: A longitudinal analysis was conducted utilizing data obtained from a previous randomized control trial that evaluated the effect of an interventional video on improving PC knowledge and attendance at outpatient PC appointments in gynecologic oncology patients receiving active treatment at a single academic tertiary care center. Women were divided into two groups: those that attended PC appointments (PC group) and those that did not (no PC group). All participants completed the FACT-G questionnaire at initial enrollment and were asked to repeat the same questionnaire at 3 and 6 months electronically. Data with complete questionnaires at the 3 and 6 month time point were utilized in analysis separately. Measurement data included demographics, FACT-G, and FACT-G sub-score results. Data analyses were performed using descriptive statistics, ANOVA, and Mann Whitney rank sums tests with a significance level of a = 0.05 Results: The initial cohort included 111 patients completing the FACT-G questionnaire: 68 (61.2%) of those completed the 3-month FACT-G questionnaire (20 PC, 48 no PC), while 30 (27%) completed the 6-month questionnaire (8 PC, 22 no PC). Baseline demographics were not significantly different between the entire cohort and respondents. The majority of patients were Caucasian, never smoked, were married, had stage III disease, had ovarian cancer, were platinum-sensitive, and were treated with primary cytoreduction. There was no statistical change in longitudinal FACT-G score at 3 months [(n=68) = 0.76, p=0.39], and 6 months [(n=30) = 0.43, p=0.66] (Table 1). Secondary analysis compared PC vs no PC group FACT-G sub-scores at baseline, 3 month and 6 months: physical well-being (GP) [(n=111, p=0.02) (n=68, p=0.11) (n=30, p=0.60)], social/family well-being (GS) [(n=111, p=0.20) (n=68, p=0.40) (n=30, p=0.38, emotional well-being (GE) [(n=111, p=0.10) (n=68, p=0.07) (n=30, p=0.85)], and functional well-being (GF) [(n=111, p=0.003) (n=68, p=0.001) (n=30, p=0.73)]. There was a statistically significant difference in GF (p=0.003) and GP (0.02) sub-scores at the initial survey, with no PC group having higher scores. By the 6-month survey, the statistical significance between groups was lost in the GF (p=0.73) and GP (p=0.60) sub-scores; noting the minimal change in the no PC scores (GF 21.5 to 20.4, GP 23 to 23.5) but with improvement in the PC scores (GF 16 to 19.8, GP 18 to 20). This suggests a potential positive impact of PC on these sub-score outcomes and quality of life. Download : Download high-res image (116KB) Download : Download full-size image Conclusions: Attending a PC appointment did not significantly improve the quality of life as assessed by FACT-G at 3 or 6-month intervals for this small cohort. However, the differences at the initial survey in the GP and GF sub-scores were no longer significant by 6 months, suggesting a positive impact of PC on these aspects. Further research should focus on investigating the effect of PC over time in a larger population as well as explore other metrics that may better identify the effect of PC on quality of life.