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J Cancer 2017; 8(9):1640-1646. doi:10.7150/jca.18875 This issue Cite

Research Paper

Integrative Oncology Outpatient Consultations: Long-Term Effects on Patient-Reported Symptoms and Quality of Life

Gabriel Lopez^1✉, Wenli Liu¹, Jennifer McQuade², Richard T Lee³, Amy R Spelman⁴, Bryan Fellman⁵, Yisheng Li⁵, Eduardo Bruera¹, Lorenzo Cohen¹

1. Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center;
2. Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center;
3. Department of Medicine, University Hospitals and Case Western Reserve University;
4. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center;
5. Department of Biostatistics, The University of Texas MD Anderson Cancer Center.

✉ Corresponding author: Gabriel Lopez

Abstract

Background: Integrative oncology (IO) seeks to bring non-conventional approaches into conventional oncology care in an evidence-based, coordinated manner. Little is known about the effects of such consultations on patient-reported symptoms.

Methods: We reviewed data from patients referred for an IO outpatient consultation between 2009 and 2013, comparing the cohort of patients with at least one follow-up to the cohort with an initial consultation only. Assessments completed at initial and follow-up encounters included: complementary and alternative medicine (CAM) use questionnaire, Measure Yourself Concerns and Wellbeing (MYCaW), Edmonton Symptom Assessment Scale (ESAS; 10 symptoms, scale 0-10, 10 worst), and post-consultation satisfaction. ESAS individual items and global (GDS; score 0-90), physical (PHS, 0-60) and psychological (PSS, 0-20) distress scales were analyzed.

Results: 642 patients out of 2,474 (26%) new patient IO consultations had at least one follow-up encounter (mean 3.2; SD 1.8). Age, place of residence, and higher satisfaction were predictors of follow-up. Statistically significant improvement in symptoms between initial consult and follow-up were observed for depression, anxiety, well-being, and subscales of GDS and PSS (all p's > 0.01). For those with moderate to severe symptoms at their initial consult (ESAS scores ≥ 4), we observed clinical response rates (improvement) of 49-75% for all ESAS symptoms at follow-up.

Conclusions: Patients presenting for IO follow-up had overall mild to moderate symptoms at baseline and stable symptom burden over time. Greatest improvements were observed for psychosocial symptoms, most pronounced for the subset of patients with moderate to severe symptoms at their initial consultation.

Keywords: Integrative Oncology, Integrative Medicine, Patient Reported Outcomes, Edmonton Symptom Assessment System, Quality of Life, Complementary Approaches.

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