ABSTRACT :
Background: Palliative care is provided to terminally ill patients with advanced disease for relieving pain and discomfort associated with their illness, to improve their quality of life. Dyspnea significantly decreases the quality of life in such patients.
Objective: To describe the profile of palliative care patients in King Fahad Medical City, Riyadh Saudi Arabia
Methods: This was a cross sectional study conducted on palliative care patients in clinics at King Fahad Medical City, Riyadh, Saudi Arabia from January 2016 – December 2020. Socio-demographic and disease related data was collected from them through a proforma. Edmonton Symptom Assessment System (ESAS) score, Palliative Performance Scale (PPS) Score, were also ascertained. Data was coded, entered, and analyzed using the Statistical Package for Social Science (SPSS) version 23. Categorical data was expressed in the form of number and percentage.
Results: Total 188 patients were included in the study. The mean age ± standard deviation was 58.14 ± 15.19 years. Among these patients, prevalence of dyspnea was 25%. Their average score for PPS was 52%. The predominant site of cancer in these patients was the breast (22.9%), or lungs (18.1%). Comorbidities included hypertension (15;8%) diabetes mellitus (13;6.9%) and ischemic heart disease (9;4.8%).
Conclusion: Palliative care patients at King Fahad Medical City, Riyadh, with mean age as 58 years had cancer of breast and lungs as the main malady. They had poor PPS Score. Prevalence of dyspnea was 25% in them.
KEY WORDS: Prevalence, Dyspnea, Palliative Care, Palliative Performance Scale, Breast Cancer, Lungs Cancer
INTRODUCTION :
Palliative care aims to enhance the quality of lives (QOL) of terminally ill patients by alleviating their pain and symptoms [1]. Dyspnea often affects palliative care patients regardless of the stage of their disease [2].
Analysis of the user profile helps in guiding the set of palliative care services. Lack of any data on patients opting for palliative care is a major barrier to proper planning of palliative services in any country. Without such information, facilities are only ad hoc in nature.
This study addresses a gap in the literature by elucidating the profile of palliative care patients, in Saudi Arabia.
METHODOLOGY:
A cross sectional study was conducted in Palliative care Outpatients Clinics at King Fahad Medical City (KFMC), Riyadh, Saudi Arabia from January 2016 – December 2020, after obtaining approval from Research Ethics committee of KFMC.
Inclusion criteria: Any patient reporting in palliative care outpatients clinics in KFMC, complaining of dyspnea grade 4 or more based on ESAS Score.
A convenient non-probability sampling technique was used to select the cases.
The Edmonton Symptom Assessment System (ESAS) and Palliative Performance Scale (PPS) Score was used in systematic symptom evaluation [3,4]. A data collecting sheet form was employed to interview the participants, to gather socio-demographic data, ESAS score, PPS, and medical condition of the patients. Data were coded, entered, and analyzed using the Statistical Package for Social Science (SPSS) version 23. Categorical data were expressed in the form of number and percentage. Chi-square (χ2) test was used to examine the association between two variables.
RESULTS:
Total 188 patient were enrolled in the current study. Their mean age was 58.14 ±15.19 years. There were 110 (58.5%) males and 78 (41.5%) females. Nationality of 183 (97.3%) of patients was Saudi Arabian (Table 1). The prevalence of dyspnea was 25%.
Table 1: Socio-demographic characteristics of the participants
| Mean ± SD | |
| Age(years) | 58.14 ± 15.19 |
| Frequency (%) | |
| Gender | |
| Male | 110 (58.5%) |
| Female | 78 (41.5%) |
| Nationality | |
| Saudi | 183 (97.3%) |
| Non-Saudi | 5 (2.7%) |
Table 2 shows the palliative PPS details of the respondents. Mean PPS was 52%.
Table 2: PPS score of the respondents
| PPS score % | Frequency (%) |
| 0-40 | 65(34.5%) |
| 50-70 | 110(58.5%) |
| 80-90 | 13(7.0%) |
The most reported site of diagnosis of cancer in these patients was the breast in 43 (22.9%) patients followed by lung in 34 (18.1%) patients (Table 3). Metastatic cancers were found in most (182 ;96.8%) of the patients. There was significant association between site of diagnosis and metastasis (p-value= 0.043) with breast, colon, lung, ovarian cancers and all other cancers with 100% metastasis; cervical cancer with 75% metastasis (P-value= 0.043).
Table 3: Site of cancer in the study population and its association with metastasis
| Site / TYPE of cancer | Frequency (%) | % cases in which Metastasis seen |
| Adeno carcinoma | 1(0.5%) | 100 |
| Bladder | 3 (1.6%) | 100 |
| Brain | 2 (1.1%) | 100 |
| Breast | 43 (22.9%) | 100 |
| Cervical cancer | 4 (2.1%) | 75 |
| Cholangiocarcinoma | 5 (2.7%) | 100 |
| Colon | 8 (4.3%) | 100 |
| Endometrial Carcinoma | 8 (4.3%) | 100 |
| Fibromatosis left Chest | 1 (.5%) | 100 |
| Floor Of Mouth | 1 (.5%) | 100 |
| Gastroesophageal | 10 (5.3%) | 70 |
| Gestational trophoblastic | 1 (.5%) | 100 |
| Hard palate low grade adenocarcinoma | 1 (.5%) | 100 |
| Hepatocellular | 4 (2.1%) | 100 |
| High grade leiomyosarcoma | 1 (.5%) | 100 |
| Kaposi Sarcoma | 2 (1.1%) | 100 |
| Laryngeal carcinoma | 2 (1.1%) | 100 |
| Light chain multiple myeloma | 1 (.5%) | 100 |
| Lung | 34 (18.1%) | 97.1 |
| Mandible | 1 (.5%) | 100 |
| Myelofibrosis | 1 (.5%) | 0 |
| Nasopharyngeal | 1 (.5%) | 100 |
| Neuroendocrine Tumor | 1 (.5%) | 100 |
| Ovarian Ca | 12 (6.4%) | 100 |
| Pancreatic | 8 (4.3%) | 100 |
| Paraganglioma | 1 (.5%) | 100 |
| Prostate | 5 (2.7%) | 100 |
| RCC | 2 (1.1%) | 100 |
| Recto-sigmoid | 12 (6.4%) | 100 |
| Synovial sarcoma | 2 (1.1%) | 100 |
| Thyroid | 5 (2.7%) | 100 |
| Unknown primary | 4 (2.1%) | 100 |
| Urothelial Renal | 1 (.5%) | 100 |
Figure 1 shows the comorbidities in the study population.
Figure 1: Associated medical conditions in the patients
DISCUSSION:
The study of the profile of patients is useful for planning palliative services in any country. It gives an idea about the problems that may be anticipated in setting up a palliative care center [5]. Thus, our study data may help authorities to make provisions for optimal palliative care facilities in the country.
The mean PPS in the current study was found to be much lower than that in the study which conducted in Saudi Arabia in which the mean PPS% was found to be 72. This could be attributed to that most the participants in the current study were with terminal metastatic cancers [6]. Also, the prevalence of dyspnea was 25% in them. Everyday activities of palliative care patients get a negative interference due to dyspnea. The perceived quality of life of these patients with any of the respiratory disorders and older individuals also gets reduced [7].
Similar results with minor differences were reported in the study which conducted by Alqahtani et al in which the most reported sites and diagnosis of cancers were breast and colon cancers followed by prostate cancer [8]. But these findings were found to be contradictory to the other findings in the other study which conducted by Chaudhri et al in which the most reported sites and diagnosis were leukemia and colon cancers [9]. Other sites of diagnosis for cancers reported in less than 5 percent of patients according to frequency including colon, endometrial carcinoma, prostate, pancreatic, thyroid, cholangiocarcinoma, hepatocellular, cervical, unknown primary, bladder, brain, laryngeal, Kaposi sarcoma, synovial, renal cell carcinoma (RCC) and others. Similar findings were reported in a study by Riihimäki et al in which colon and lung cancer were the most frequently reported metastatic cancers [10]. In some parallel studies, hypertension and dyslipidemia were the most reported co-morbidities in cancer patients like our findings [11-12].
CONCLUSION:
Palliative care patients at King Fahad Medical City, Riyadh, with mean age as 58 years had cancer of breast and lungs as the main malady. They had poor PPS Score. Prevalence of dyspnea was 25% in them.
Recommendations: The prominence of breast and lung cancers underscores the role of anatomical sites in symptom manifestation. With limited comorbidities, there’s an opportunity to enhance palliative care strategies, particularly for cancer patients. More efforts should be dedicated for improvement palliative care delivered for cancer patients.
Author’s Contribution Statement: The study was conceptualized and the methodology was developed by SS. SS also supervised the entire study and prepared the original draft. KG was responsible for data collection and analysis and contributed to the writing, review, and editing of the manuscript. AS contributed to the interpretation of data and critically revised the manuscript for important intellectual content. Additionally, all authors assisted in writing, reviewing, and editing the manuscript. All authors have read and approved the final manuscript.
Funding: This study received no financial support from any external sources.
Ethics Approval and Consent to Participate: Approval for this study was granted by the Institutional Review Board of King Fahad Medical City, Riyadh, Saudi Arabia. All procedures involving human participants were conducted in compliance with the ethical standards of the institutional research committee.
Availability of Data and Materials: The datasets generated and/or analyzed during the study can be obtained from the corresponding author upon reasonable request.
Conflict of Interest: The authors affirm that they do not have any conflicts of interest.
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