Specialty palliative care reduces pain severity in most adolescents and young adults (AYAs) with cancer, but work remains to reduce other symptoms, a recent study found.
The study, published in JAMA by Canadian researcher Dr. Sumit Gupta and co-authors, reviewed data from 5,435 AYAs with cancer between the ages of 15- and 29-years-old.
Regular symptom assessments are key
The researchers found that AYAs who reported moderate or severe symptoms through the Edmonton Symptom Assessment Scale (ESAS) were more likely to receive specialty palliative care. The more severe the reported symptoms, the more likely they were to receive care.
Adolescents and young adults who were not screened with ESAS were unlikely to receive any palliative care.
“The system we have in Ontario… asked about their symptoms at every visit,” Gupta told Palliative Care News. “It does raise the question of whether systematic programs of asking AYA and other cancer patients for symptoms at regular intervals can serve as triggers or as a way to get palliative care involved more often.”
In a commentary on the study, Ursula Sanson-Daly, a professor at the University of New South Wales in Australia, agreed, “The findings from Gupta and colleagues suggest an important role for the integration of systematic patient-reported outcome measures to prompt palliative care referrals as part of standard practice.”
Palliative care reduces pain severity
The study discovered that specialty palliative care improved pain scores for adolescents and young adults with cancer. However, it had little impact on other symptoms such as fatigue, anxiety, depression and dyspnea.
Toward the end of life, the weight of symptoms grows heavier for AYAs with cancer. Making an impact on even one of those symptoms, especially a significant one like pain, provides a higher quality of life.
The principles of pain management between adults and AYAs are similar, but how those principles are applied differs due to the perception of pain. AYA patients often experience severe symptoms, receive intensive, high-acuity care and die in the hospital rather than at home.
“How AYAs rate their pain, where they rate the sources of pain, and what interventions they find most useful may well differ as a group between AYAs and other patients,” Gupta said.
The need for earlier and greater access
Expanding palliative care to more AYAs with cancer and offering it earlier could significantly improve the quality of life for patients and their families.
“I think you can extrapolate from our [study] saying, well, the palliative care does make a difference—even if it’s just in pain,” Gupta said. “Then, the more time you have palliative care involved, the more impact you’re going to have on every symptom.”
Additionally, AYAs may not experience positive changes to other symptoms because there simply has not been enough time for the palliative care team’s interventions to succeed.
“Many health interventions require personalization and time to yield clinically significant, meaningful effects,” Sanson-Daly wrote in the commentary. “The fact that palliative care interventions showed some symptom benefits in this analysis remains encouraging.”
Research is needed to develop new interventions
New interventions are needed to address the symptoms other than pain, Gupta indicated.
Currently, evidence-based guidelines for cancer pain management exist, enabling palliative care professionals to personalize and implement them with better results.
The lack of research and thoroughly-vetted guidelines for treatments of other symptoms may be limiting the effectiveness of palliative care teams.
“There are interventions that people turn to for anxiety, for depression, for fatigue — both pharmacologic and nonpharmacologic,” Gupta said. “But they’re not quite as rigorously proven. There aren’t the same type of multi-step detailed guidelines … I think where research is needed is exactly that.”
