Research paperProspective analysis of patient reported symptoms and quality of life in patients with incurable lung cancer treated in a rapid access clinic

- The VARA clinic provides access to palliative radiotherapy and supportive care.
- Collection of patient reported outcomes is feasible in this palliative population.
- Clinic visits are associated with improved patient reported quality of life.
- Palliative radiotherapy is effective for respiratory symptoms and bone pain.

IntroductionThe Vancouver Rapid Access (VARA) clinic was designed to provide palliative radiotherapy and holistic care to patients with incurable lung cancer. Analysis of the pilot phase demonstrated improved radiotherapy wait-times and access to supportive services compared to standard practice. This study aims to prospectively assess the impact of the clinic on patient reported symptoms and quality of life.Materials and methodsPatient assessments are completed at baseline and by a telephone follow up four-weeks later using Likert scales adapted from the Edmonton Symptom Assessment System (scale 0-10) and European Organization for Research and Treatment of Cancer questionnaires (scale 1-4). Patient reported outcomes at follow-up are compared to baseline using wilcoxon signed-rank test for categorical variables and paired sample t-test for continuous variables.ResultsBaseline data was collected on 125 patients, 109 received palliative radiotherapy (87%). At the 4 week follow up, 22 patients had died. Seventy-one of the remaining 103 patients completed the follow-up questionnaire, resulting in a 69% response rate among survivors. The mean patient reported overall health score, improved from 4.8 to 6.1 (p < 0.01). All respiratory symptoms except chest pain (p = 0.06) were associated with a statistically significant improvement after the clinic, whereas all respiratory symptoms improved post radiotherapy. Mean bone pain scores decreased from 5.5 to 2.7 (p < 0.01). Assessment of symptoms secondary to brain metastases is limited by small patient numbers.ConclusionThe VARA clinic provides timely access to palliative radiotherapy and supportive services resulting in improved patient reported outcomes. Despite a high symptom and disease burden, patients report improved overall health and palliation of respiratory symptoms and bony pain. The studies completed on the VARA clinic to date, continue to support its value in our center.